Lynn D Wenger1, Andrea M Lopez2, Alex H Kral2, Ricky N Bluthenthal3. 1. Behavioral and Urban Health Program, RTI International, San Francisco Regional Office, 351 California St. Suite 500, San Francisco, CA 94104, USA. Electronic address: lynndee@rti.org. 2. Behavioral and Urban Health Program, RTI International, San Francisco Regional Office, 351 California St. Suite 500, San Francisco, CA 94104, USA. 3. Department of Preventative Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, Soto Street Building, SSB, 2001 N. Soto Street, 3rd Floor MC 9239, Los Angeles, CA 90033, USA.
Abstract
BACKGROUND: Research has shown that people often need assistance from an established person who injects drugs (PWID) in order to initiate their own injection drug use. Yet, there is scant research on the injection initiation process from the perspective of established PWID who assists with initiation. In this paper, we examine the injection initiation process from the perspective of established PWID. METHODS: From 2011 to 2013, we conducted qualitative life history interviews with 113 PWID in San Francisco and Los Angeles, California. Qualitative data were coded using an inductive analysis approach. Emergent themes are presented in a series of emblematic case studies that elucidate the injection initiation process from the point of view of the PWID who help people with their first injection. RESULTS: Most participants (70%) said that they had never initiated another person into drug injection, citing negative health and social consequences of drug injection as their primary reasons. Among those PWID who had ever facilitated initiation (30%), most expressed moral ambivalence about the behaviour. Using case studies, we show how PWID engage in a complicated calculation that weighs the pros and cons of assisting someone with their first injection. Concerns about long term harms associated with injection drug use sometimes give way to short-term altruistic concerns related to self-initiation or instrumental needs on the part of the established PWID. CONCLUSIONS: Objections to facilitating initiation of injection naïve persons appear to be common among established PWID but are sometimes overridden by a need to reduce harms that can be associated with self-initiation and one's structural vulnerability. For established PWID, helping to initiate another person becomes a complex moral question with nuanced motivations. While further substantiation of this observation will require more research, it is worth considering how existing disinclination to initiating injection naïve persons can be integrated into new or existing approaches to preventing injection initiation.
BACKGROUND: Research has shown that people often need assistance from an established person who injects drugs (PWID) in order to initiate their own injection drug use. Yet, there is scant research on the injection initiation process from the perspective of established PWID who assists with initiation. In this paper, we examine the injection initiation process from the perspective of established PWID. METHODS: From 2011 to 2013, we conducted qualitative life history interviews with 113 PWID in San Francisco and Los Angeles, California. Qualitative data were coded using an inductive analysis approach. Emergent themes are presented in a series of emblematic case studies that elucidate the injection initiation process from the point of view of the PWID who help people with their first injection. RESULTS: Most participants (70%) said that they had never initiated another person into drug injection, citing negative health and social consequences of drug injection as their primary reasons. Among those PWID who had ever facilitated initiation (30%), most expressed moral ambivalence about the behaviour. Using case studies, we show how PWID engage in a complicated calculation that weighs the pros and cons of assisting someone with their first injection. Concerns about long term harms associated with injection drug use sometimes give way to short-term altruistic concerns related to self-initiation or instrumental needs on the part of the established PWID. CONCLUSIONS: Objections to facilitating initiation of injection naïve persons appear to be common among established PWID but are sometimes overridden by a need to reduce harms that can be associated with self-initiation and one's structural vulnerability. For established PWID, helping to initiate another person becomes a complex moral question with nuanced motivations. While further substantiation of this observation will require more research, it is worth considering how existing disinclination to initiating injection naïve persons can be integrated into new or existing approaches to preventing injection initiation.
Authors: Ricky N Bluthenthal; Lynn Wenger; Daniel Chu; Philippe Bourgois; Alex H Kral Journal: Drug Alcohol Depend Date: 2017-04-19 Impact factor: 4.492
Authors: Stephanie Navarro; Alex H Kral; Carol S Strike; Kelsey Simpson; Lynn Wenger; Ricky N Bluthenthal Journal: Subst Use Misuse Date: 2019-05-03 Impact factor: 2.164
Authors: Andy Guise; Jason Melo; Maria Luisa Mittal; Claudia Rafful; Jazmine Cuevas-Mota; Peter Davidson; Richard S Garfein; Dan Werb Journal: Int J Drug Policy Date: 2018-03-07
Authors: Kelsey A Simpson; Alex H Kral; Jesse L Goldshear; Lynn Wenger; Carol S Strike; Ricky N Bluthenthal Journal: Drug Alcohol Depend Date: 2020-02-05 Impact factor: 4.492
Authors: Rebecca Hamilton White; Allison O'Rourke; Ricky N Bluthenthal; Alex H Kral; Michael E Kilkenny; Tim D Hazelett; Susan G Sherman; Sean T Allen Journal: Subst Use Misuse Date: 2019-10-08 Impact factor: 2.164
Authors: Anneli Uusküla; David M Barnes; Mait Raag; Ave Talu; Susan Tross; Don C Des Jarlais Journal: Drug Alcohol Depend Date: 2018-05-08 Impact factor: 4.492
Authors: Maria L Mittal; Andrew Guise; Claudia Rafful; Patricia Gonzalez-Zuñiga; Peter Davidson; Devesh Vashishtha; Steffanie A Strathdee; Dan Werb Journal: Subst Use Misuse Date: 2019-08-07 Impact factor: 2.164