Circumstances, Pedagogy and Rationales for Injection Initiation Among New Drug Injectors

Abstract

Injection drug use is especially risky for new injectors. To understand the social and environmental contexts in which risks occur, we interviewed individuals who had initiated injection within the past 3 years (n = 146, 69.2% male) about the circumstances and rationales for their initial injection events. Respondents typically initiated injection due to tolerance (49.3%) and/or for experimentation (61.1%). Most (86.2%) did not possess the technical skills required to self-inject, and relied on the assistance of someone older (58.5%). While low levels of syringe sharing (5.8%) were reported, a majority of respondents (60.5%) engaged in at least one type of behavioral risk. Female injectors were more likely than male injectors to rely on another individual (95.5 vs. 82.2%), often a sex partner (40.5 vs. 7.2%), for assistance. The diversity seen in early injection practices highlights the need for tailored prevention messages to reach this population prior to the onset of injection risk.

Changing patterns of first injection across key periods of the French Harm Reduction Policy: PrimInject, a cross sectional analysis

“…In total, 87% of the oldest group respondents reported receiving an injection from another person, which is consistent with earlier findings for long-term drug users in France (Vidal-Trecan et al, 2002). In recent studies, the percentage of individuals performing the first injection alone ranged from 8% to 26% (Goldsamt et al, 2010;Hadland et al, 2010;Lankenau et al, 2010;Novelli et al, 2005). One must consider the deep social transformations in France to understand these new patterns of initiation into injection.…”

“…Circumstances leading to injection in the new groups of injectors have not been well documented because the majority of studies have focused on the trajectory of long-term drug users, often the most marginalized, who are mainly recruited through drug dependence clinics or injection drug user networks (Crofts et al 1996;Doherty et al, 2000;Frajzyngier et al, 2007;Fuller et al, 2003;Goldsamt et al, 2010;Hadland et al, 2010;Kerr et al, 2007;Lankenau et al, 2010;Roy et al, 2003;Vidal-Trecan et al, 2002). The context of initiation for those who have injected only a few times or over a short period of time during their lifetime has been poorly described.…”

Factors associated with initiating someone into illicit drug injection

“…These studies have described the circumstances of first injection episodes and examined a wide range of individual, dyadic, social network, and community factors associated with initiation. Factors found to influence injection initiation include pragmatics of drug use such as the greater drug effects (i.e., better “high”) and lower cost per use when drugs are injected (Crofts et al, 1996; Fitzgerald et al, 1999; Goldsamt et al, 2010; Kermode et al, 2009; Swift et al, 1999; Witteveen et al, 2006). Socio-demographic and economic factors positively associated with injection initiation include being male, race (typically not African Americans), sex work, and poverty and homelessness (Crofts et al, 1996; Feng et al, 2013; Fuller et al, 2001, 2002; Hadland et al, 2012; Kuo et al, 2007; Miller et al, 2011; Nasir and Rosenthal, 2009; Roy et al, 2011; Sherman et al, 2005; Stenbacka, 1990).…”

“…Socio-demographic and economic factors positively associated with injection initiation include being male, race (typically not African Americans), sex work, and poverty and homelessness (Crofts et al, 1996; Feng et al, 2013; Fuller et al, 2001, 2002; Hadland et al, 2012; Kuo et al, 2007; Miller et al, 2011; Nasir and Rosenthal, 2009; Roy et al, 2011; Sherman et al, 2005; Stenbacka, 1990). Further, social network characteristics and personal relationships such as having good friends or an intimate partner (e.g., girlfriend or boyfriend) who inject have also been repeatedly positively associated with initiation into injection (Bryant and Treloar, 2007; Crofts et al, 1996; Doherty et al, 2000; Goldsamt et al, 2010; Harocopos et al, 2008; Kermode et al, 2009, 2007; Khobzi et al, 2008; Neaigus et al, 2006; Roy et al, 2011; Simmons et al, 2012; Stenbacka, 1990; Stillwell et al, 1999). Lastly, a history of childhood physical and sexual abuse has been associated with increased risk for injection initiation (Hadland et al, 2012; Neaigus et al, 2006; Ompad et al, 2005; Roy et al, 2010, 2003).…”

Characteristics of people who initiate injection drug use later in life

“…Because many of the health risks of injection occur rapidly after initiation, studies on injection initiation have focused on people who inject drugs (PWID) under 30 years of age (Abelson et al, 2006; Dunn et al, 2010; Feng et al, 2013; Frajzyngier et al, 2007; Fuller et al, 2001; Goldsamt et al, 2010; Lankenau et al, 2012, 2010; Mackesy-Amiti et al, 2013; Miller et al, 2011; Novelli et al, 2005; Parriott and Auerswald, 2009; Roy et al, 2011). This focus reflects the persistent observation that most PWIDs initiate drug injection in their late teens and early twenties.…”