{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T18:18:48Z","timestamp":1791137928484,"version":"4.1.0"},"reference-count":53,"publisher":"BMJ","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Epidemiol Community Health"],"published-print":{"date-parts":[[2001,5,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>To study community wide trends in injecting prevalence and trends in injecting transitions, and determinants.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>DESIGN<\/jats:title>\n                  <jats:p>Open cohort study with follow up every four months (Amsterdam Cohort Study). Generalised estimating equations were used for statistical analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>SETTING<\/jats:title>\n                  <jats:p>Amsterdam has adopted a harm reduction approach as drug policy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PARTICIPANTS<\/jats:title>\n                  <jats:p>996 drug users who were recruited from 1986 to 1998, mainly at methadone programmes, who paid 13\u2009620 cohort visits.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>MAIN RESULTS<\/jats:title>\n                  <jats:p>The prevalence of injecting decreased exponentially (66% to 36% in four to six monthly periods). Selective mortality and migration could maximally explain 33% of this decline. Instead, injecting initiation linearly decreased (4.1% to 0.7% per visit), cessation exponentially increased (10.0% to 17.1%), and relapse linearly decreased (21.3% to 11.8%). Non-injecting cocaine use (mainly pre-cooked, comparable to crack) and heroin use strongly increased. Trends were not attributable to changes in the study sample.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Harm reduction, including large scale needle exchange programmes, does not lead to an increase in injecting drug use. The injecting decline seems mainly attributable to ecological factors (for example, drug culture and market). Prevention of injecting is possible and peer-based interventions may be effective. The consequences of the recent upsurge in crack use requires further study.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech.55.5.356","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T06:33:18Z","timestamp":1027751598000},"page":"356-363","source":"Crossref","is-referenced-by-count":82,"title":["Large decline in injecting drug use in Amsterdam, 1986\u20131998: explanatory mechanisms and determinants of injecting transitions"],"prefix":"10.1136","volume":"55","author":[{"given":"E J C","family":"van Ameijden","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R A","family":"Coutinho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2001,5,1]]},"reference":[{"key":"2025100301473115000_55.5.356.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0033-3506(97)00053-X"},{"key":"2025100301473115000_55.5.356.2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a008752"},{"key":"2025100301473115000_55.5.356.3","doi-asserted-by":"publisher","DOI":"10.1007\/BF00146260"},{"key":"2025100301473115000_55.5.356.4","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(96)00180-1"},{"key":"2025100301473115000_55.5.356.5","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2000.9533839.x"},{"key":"2025100301473115000_55.5.356.6","doi-asserted-by":"publisher","DOI":"10.1016\/0899-3289(92)90023-Q"},{"key":"2025100301473115000_55.5.356.7","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-199205000-00005"},{"key":"2025100301473115000_55.5.356.8","doi-asserted-by":"publisher","DOI":"10.1016\/0376-8716(94)90131-7"},{"key":"2025100301473115000_55.5.356.9","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/0376-8716(94)90131-7","article-title":"Injecting behaviour and risky needle use amongst methadone maintenance clients.","volume":"34","author":"White","year":"1994","journal-title":"Drug Alcohol Depend"},{"key":"2025100301473115000_55.5.356.10","first-page":"s71","article-title":"Can HIV epidemics among injection drug users be prevented?.","volume":"12 (suppl A)","author":"Strathdee","year":"1998","journal-title":"AIDS"},{"key":"2025100301473115000_55.5.356.11","first-page":"s75","article-title":"Interventions among injecting drug users: do they work?","volume":"9 (suppl A)","author":"van Ameijden","year":"1995","journal-title":"AIDS"},{"key":"2025100301473115000_55.5.356.12","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199708000-00001"},{"key":"2025100301473115000_55.5.356.13","doi-asserted-by":"crossref","first-page":"F59","DOI":"10.1097\/00002030-199708000-00001","article-title":"Needle exchange is not emough: lessons from the Vancouver injecting drug use study.","volume":"11","author":"Strathdee","year":"1997","journal-title":"AIDS"},{"key":"2025100301473115000_55.5.356.14","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.1999.947105110.x"},{"key":"2025100301473115000_55.5.356.15","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.86.5.655"},{"key":"2025100301473115000_55.5.356.16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1992.tb01950.x"},{"key":"2025100301473115000_55.5.356.17","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1111\/j.1360-0443.1992.tb01950.x","article-title":"AIDS and the transition to illicit drug injection - results of a randomised trial prevention program.","volume":"87","author":"Des Jarlais","year":"1992","journal-title":"Br J Addict"},{"key":"2025100301473115000_55.5.356.18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1991.tb03421.x"},{"key":"2025100301473115000_55.5.356.19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1992.tb01939.x"},{"key":"2025100301473115000_55.5.356.20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1997.tb02895.x"},{"key":"2025100301473115000_55.5.356.21","doi-asserted-by":"publisher","DOI":"10.1016\/0376-8716(95)01208-7"},{"key":"2025100301473115000_55.5.356.22","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03510260053028"},{"key":"2025100301473115000_55.5.356.23","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199612000-00018"},{"key":"2025100301473115000_55.5.356.24","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1097\/00002030-199612000-00018","article-title":"Needle exchange use among a cohort of injecting drug users.","volume":"10","author":"Schoenbaum","year":"1996","journal-title":"AIDS"},{"key":"2025100301473115000_55.5.356.25","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1097\/00002030-199404000-00016","article-title":"Edinburgh drug users: are they injecting and sharing less?","volume":"8","author":"Peters","year":"1994","journal-title":"AIDS"},{"key":"2025100301473115000_55.5.356.26","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1136\/bmj.309.6951.369","article-title":"Deaths, HIV infection, abstinence and other outcomes in a cohort of injecting drug users followed for 10 years.","volume":"309","author":"Robertson","year":"1994","journal-title":"BMJ"},{"key":"2025100301473115000_55.5.356.27","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1097\/00002030-199610090-00013","article-title":"Risk factors for intravenous drug use and sharing equipment among young male drug users in Longchuan County, south-west China.","volume":"10","author":"Wu","year":"1996","journal-title":"AIDS"},{"key":"2025100301473115000_55.5.356.28","unstructured":"van Ameijden EJC van den Hoek JAR (1998) AIDS among injecting drug users in The Netherlands: The epidemic and the response. in The Dutch response to HIV: pragmatism and consensus. ed Santfort T (Taylor and Francis, London), pp 61\u201385."},{"key":"2025100301473115000_55.5.356.29","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2000.95459110.x"},{"key":"2025100301473115000_55.5.356.30","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1046\/j.1360-0443.2000.95459110.x","article-title":"Methadone maintenance and cessation of injecting drug use: results from the Amsterdam Cohort Study.","volume":"95","author":"Langendam","year":"2000","journal-title":"Addiction"},{"key":"2025100301473115000_55.5.356.31","unstructured":"Lurie P Reingold AL Browser B (1993) The public health impact of needle exchange programs in the united states and abroad. (University of California, San Francisco)."},{"key":"2025100301473115000_55.5.356.32","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1001\/jama.1994.03510260047027","article-title":"Syringe and needle exchange as HIV\/AIDS prevention for drug users.","volume":"271","author":"Watters","year":"1994","journal-title":"JAMA"},{"key":"2025100301473115000_55.5.356.33","first-page":"16","article-title":"Verslaafde opa's em oma's.","volume":"13","author":"Buster","year":"1996","journal-title":"Amsterdams Drug Tijdschrift"},{"key":"2025100301473115000_55.5.356.34","unstructured":"Buning EC (1990) De GG&GD en het drugprobleem in cijfers IV. (Municipal Health Service, Amsterdam)."},{"key":"2025100301473115000_55.5.356.35","unstructured":"Fennema JSA van Ameijden EJC Wiessing L (1998) No evidence that harm reduction approach leads to increase in injection behavior in amsterdam, 1989\u20131996. Fennema H. HIV infection among drug users and the potential for heterosexual spread. [PhD thesis]. (University of Amsterdam, Amsterdam), pp 53\u201362."},{"key":"2025100301473115000_55.5.356.36","doi-asserted-by":"publisher","DOI":"10.2307\/2531248"},{"key":"2025100301473115000_55.5.356.37","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/28.3.514"},{"key":"2025100301473115000_55.5.356.38","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1093\/ije\/28.3.514","article-title":"The validity of drug users' self-reports in a non-treatment setting: prevalence and predictors of incorrect reporting methadone treatment modalities.","volume":"28","author":"Langendam","year":"1999","journal-title":"Int J Epidemiol"},{"key":"2025100301473115000_55.5.356.39","first-page":"125","article-title":"Motieven voor en methoden van stoppen met spuiten onder Amsterdamse druggebruikers: Een kwalitatieve studie.","volume":"24","author":"Witteveen","year":"2000","journal-title":"Tijdschrift voor Alcohol, Drugs en andere Psychotrope Stoffen"},{"key":"2025100301473115000_55.5.356.40","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1997.tb02867.x"},{"key":"2025100301473115000_55.5.356.41","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1111\/j.1360-0443.1997.tb02867.x","article-title":"Young and recent-onset injection drug users are at higher risk for HIV.","volume":"92","author":"Fennema","year":"1997","journal-title":"Addiction"},{"key":"2025100301473115000_55.5.356.42","unstructured":"Roy E Haley N Boivin JF (1998) Predictors of drug injection initiation in a street youth cohort. (12th World AIDS Conference, Geneva) , abstract 33389.."},{"key":"2025100301473115000_55.5.356.43","unstructured":"Neaigus A Friedman SR Hagen DL (1998) Transitions to injecting and seroconversions for HIV, hepatitis B and hepatitis C among non-injecting heroin users. (12th World AIDS Conference, Geneva) , abstract 13382.."},{"key":"2025100301473115000_55.5.356.44","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1992.tb01949.x"},{"key":"2025100301473115000_55.5.356.45","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1994.tb02784.x"},{"key":"2025100301473115000_55.5.356.46","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1111\/j.1360-0443.1994.tb02784.x","article-title":"Transitions between routes of administration of regular amphetamine users.","volume":"89","author":"Darke","year":"1994","journal-title":"Addiction"},{"key":"2025100301473115000_55.5.356.47","unstructured":"Anonymous (1998) Het Spoor Bijster: Rondhangende jongeren op Amsterdam Centraal station. (Stichting Mainline, Amsterdam)."},{"key":"2025100301473115000_55.5.356.48","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.1996.918118710.x"},{"key":"2025100301473115000_55.5.356.49","doi-asserted-by":"publisher","DOI":"10.1016\/0376-8716(96)01262-8"},{"key":"2025100301473115000_55.5.356.50","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1991.tb01876.x"},{"key":"2025100301473115000_55.5.356.51","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1995.tb03557.x"},{"key":"2025100301473115000_55.5.356.52","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1111\/j.1360-0443.1995.tb03557.x","article-title":"Crack use and injection on the increase among injecting drug users in London.","volume":"90","author":"Hunter","year":"1995","journal-title":"Addiction"},{"key":"2025100301473115000_55.5.356.53","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1136\/jech.52.3.172","article-title":"Cocaine use among heroin users in Spain: the diffusion of crack and cocaine smoking.","volume":"52","author":"Barrio","year":"1998","journal-title":"J Epidemiol Community Health"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech.55.5.356","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T08:47:41Z","timestamp":1759481261000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech.55.5.356"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2001,5,1]]},"references-count":53,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2001,5,1]]},"published-print":{"date-parts":[[2001,5,1]]}},"alternative-id":["10.1136\/jech.55.5.356"],"URL":"https:\/\/doi.org\/10.1136\/jech.55.5.356","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2001,5,1]]}}}