Abstract
Background
Injection drug use initiation is shaped by social networks and structural contexts, with people who inject drugs often assisting in this process. We sought to explore the norms and contexts linked to assisting others to initiate injection drug use in San Diego, USA, to inform the development of structural interventions to prevent this phenomenon.
Methods
We undertook qualitative interviews with a purposive sample of people who inject drugs and had reported assisting others to initiate injection (n=17) and a sub-sample of people who inject drugs (n=4) who had not reported initiating others to triangulate accounts. We analyzed data thematically and abductively.
Results
Respondents’ accounts of providing initiation assistance were consistent with themes and motives reported in other contexts: of seeking to reduce harm to the ‘initiate’, responding to requests for help, fostering pleasure, accessing resources, and claims that initiation assistance was unintentional. We developed analysis of these themes to explore initiation assistance as governed by a ‘moral code’. We delineate a fragmented moral code which includes a range of meanings and social contexts that shape initiation assistance. We also show how assistance is happening within a structural context that limits discussion of injection drug use, reflecting a prevailing silence on drug use linked to stigma and criminalization.
Conclusions
In San Diego, the assistance of others to initiate injection drug use is governed by a fragmented moral code situated within particular social norms and contexts. Interventions that address the social and structural conditions shaped by and shaping this code may be beneficial, in tandem with efforts to support safe injection and the reduction of injection-related harms.
Injection drug use initiation is shaped by social networks and structural contexts, with people who inject drugs often assisting in this process. We sought to explore the norms and contexts linked to assisting others to initiate injection drug use in San Diego, USA, to inform the development of structural interventions to prevent this phenomenon.
Methods
We undertook qualitative interviews with a purposive sample of people who inject drugs and had reported assisting others to initiate injection (n=17) and a sub-sample of people who inject drugs (n=4) who had not reported initiating others to triangulate accounts. We analyzed data thematically and abductively.
Results
Respondents’ accounts of providing initiation assistance were consistent with themes and motives reported in other contexts: of seeking to reduce harm to the ‘initiate’, responding to requests for help, fostering pleasure, accessing resources, and claims that initiation assistance was unintentional. We developed analysis of these themes to explore initiation assistance as governed by a ‘moral code’. We delineate a fragmented moral code which includes a range of meanings and social contexts that shape initiation assistance. We also show how assistance is happening within a structural context that limits discussion of injection drug use, reflecting a prevailing silence on drug use linked to stigma and criminalization.
Conclusions
In San Diego, the assistance of others to initiate injection drug use is governed by a fragmented moral code situated within particular social norms and contexts. Interventions that address the social and structural conditions shaped by and shaping this code may be beneficial, in tandem with efforts to support safe injection and the reduction of injection-related harms.
Original language | English |
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Pages (from-to) | 51-60 |
Journal | International Journal of Drug Policy |
Volume | 55 |
Early online date | 7 Mar 2018 |
Publication status | Published - May 2018 |