Injection drug users’ perceived barriers to using self-initiated harm reduction strategies

Bonar, Erin E.; Rosenberg, Harold

doi:10.3109/16066359.2013.838225

Cited by 15 publications

(15 citation statements)

References 23 publications

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“…A large proportion of participants also reported craving, time constraints, inconvenience, lack of access to needles in places where one injects, and hassles from pharmacy staff when trying to purchase needles. Barriers in this study are similar to those found in other risk reduction barrier studies with PWID (e.g., Bonar & Rosenberg, 2014). As hypothesized, the data suggests that PWID who perceive greater barriers to both skin and needle cleaning actually engage in the behaviors less than those who report fewer barriers.…”

Section: Discussionsupporting

confidence: 87%

“…Bonar and Rosenberg (2014) examined obstacles of two specific risk reduction practices – skin cleaning before injecting and using a test shot – and found that rushing to inject was the most commonly reported barrier for both risk reduction practices, while already purchasing drugs from a known dealer and lack of access to cleaning supplies were commonly reported barriers to doing a test shot and cleaning one’s skin (respectively). Additional barriers – including wanting to get high, being in withdrawal, and time pressures – were consistent with barriers reported in other studies.…”

Section: Introductionmentioning

confidence: 99%

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Barriers to practicing risk reduction strategies among people who inject drugs

Phillips

2015

Addiction Research & Theory

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Introduction and Aims People who inject drugs (PWID) engage in practices that put them at risk for various infections and overdose. The primary aim of this study was to examine common barriers to engaging in two risk reduction practices – cleaning one’s skin at the injection site and always using new needles to inject – among heroin injectors in Denver, CO. Method In 2010, 48 PWIDs were recruited through street outreach and completed a structured interview that included questions on the frequency of specific risk reduction practices (skin cleaning and using new needles) and barriers associated with these practices. Results Though many of the reported barriers were similar across the two practices, the most common barriers associated with skin cleaning included being in withdrawal and not being prepared with materials prior to injection. Fear of being arrested and being in withdrawal were most frequently reported for using new needles. Multivariate and t-test analyses demonstrated that individuals who skin cleaned and used new needles more frequently reported less barriers to these practices. Conclusions Participants reported a number of barriers to risk reduction, including those that are within the personal control of the injector, barriers that are consequences of addiction or psychological problems, and those that are structural or a function of the risk environment. Statistical analysis found that PWIDs who were more likely to skin clean and use new needles reported less barriers. Addressing barriers when intervening with PWID appears important to increase the success of risk reduction interventions.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Barriers to practicing risk reduction strategies among people who inject drugs

Phillips

2015

Addiction Research & Theory

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“…One survey of the self-efficacy of harm reduction practices, including tester shots, found that adherence to all harm reduction strategies surveyed was markedly lower when respondents were asked to imagine being in withdrawal [ 80 ]. A later study identified being in a hurry to use (24%) and purchasing drugs from a known dealer (20%) as the most significant barriers to the adoption of tester shots [ 81 ]. Health beliefs about perceived susceptibility to and severity of overdose may influence the adoption of overdose-related harm reduction methods such as tester shots [ 82 ].…”

Section: Discussionmentioning

confidence: 99%

Toots, tastes and tester shots: user accounts of drug sampling methods for gauging heroin potency

Mars

Ondocsin²,

Ciccarone

2018

Harm Reduct J

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BackgroundInternationally, overdose is the primary cause of death among people injecting drugs. However, since 2001, heroin-related overdose deaths in the United States (US) have risen sixfold, paralleled by a rise in the death rate attributed to synthetic opioids, particularly the fentanyls. This paper considers the adaptations some US heroin injectors are making to protect themselves from these risks.MethodsBetween 2015 and 2016, a team of ethnographers collected data through semi-structured interviews and observation captured in field notes and video recording of heroin preparation/consumption. Ninety-one current heroin injectors were interviewed (Baltimore, n = 22; Chicago, n = 24; Massachusetts and New Hampshire, n = 36; San Francisco, n = 9). Experience injecting heroin ranged from < 1–47 years. Eight participants, who were exclusively heroin snorters, were also interviewed. Data were analyzed thematically.ResultsAcross the study sites, multiple methods of sampling “heroin” were identified, sometimes used in combination, ranging from non-injecting routes (snorting, smoking or tasting a small amount prior to injection) to injecting a partial dose and waiting. Partial injection took different forms: a “slow shot” where the user injected a portion of the solution in the syringe, keeping the needle in the injection site, and continuing or withdrawing the syringe or a “tester shot” where the solution was divided into separate injections. Other techniques included getting feedback from others using heroin of the same batch or observing those with higher tolerance injecting heroin from the same batch before judging how much to inject themselves. Although a minority of those interviewed described using these drug sampling techniques, there is clearly receptivity among some users to protecting themselves by using a variety of methods.ConclusionsThe use of drug sampling as a means of preventing an overdose from injection drug use reduces the quantity absorbed at any one time allowing users to monitor drug strength and titrate their dose accordingly. Given the highly unpredictable potency of the drugs currently being sold as heroin in the US, universal precautions should be adopted more widely. Further research is needed into facilitators and barriers to the uptake of these drug sampling methods.

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“…When examining the relationship between PWUD and people who sell drugs, PWUD often describe high levels of trust when buying from their "regular" drug seller [6,7], and consider a long and trusted relationship with the person selling them drugs as a source of protection against overdose [8][9][10]. PWUD frequently cite buying from a trusted or known drug seller as a harm reduction strategy that they engage in [8][9][10][11]; despite this, harm reduction programming and research has been slow to engage with people who sell drugs directly.…”

Section: Introductionmentioning

confidence: 99%

Practices of care among people who buy, use, and sell drugs in community settings

Kolla

Strike

2020

Harm Reduct J

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Background: Popular perception of people who sell drugs is negative, with drug selling framed as predatory and morally reprehensible. In contrast, people who use drugs (PWUD) often describe positive perceptions of the people who sell them drugs. The "Satellite Sites" program in Toronto, Canada, provides harm reduction services in the community spaces where people gather to buy, use, and sell drugs. This program hires PWUD-who may move into and out of drug selling-as harm reduction workers. In this paper, we examine the integration of people who sell drugs directly into harm reduction service provision, and their practices of care with other PWUD in their community. Methods: Data collection included participant observation within the Satellite Sites over a 7-month period in 2016-2017, complemented by 20 semi-structured interviews with Satellite Site workers, clients, and program supervisors. Thematic analysis was used to examine practices of care emerging from the activities of Satellite Site workers, including those circulating around drug selling and sharing behaviors. Results: Satellite Site workers engage in a variety of practices of care with PWUD accessing their sites. Distribution of harm reduction equipment is more easily visible as a practice of care because it conforms to normative framings of care. Criminalization, coupled with negative framings of drug selling as predatory, contributes to the difficultly in examining acts of mutual aid and care that surround drug selling as practices of care. By taking seriously the importance for PWUD of procuring good quality drugs, a wider variety of practices of care are made visible. These additional practices of care include assistance in buying drugs, information on drug potency, and refusal to sell drugs that are perceived to be too strong. Conclusion: Our results suggest a potential for harm reduction programs to incorporate some people who sell drugs into programming. Taking practices of care seriously may remove some barriers to integration of people who sell drugs into harm reduction programming, and assist in the development of more pertinent interventions that understand the key role of drug buying and selling within the lives of PWUD.

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Injection drug users’ perceived barriers to using self-initiated harm reduction strategies

Cited by 15 publications

References 23 publications

Barriers to practicing risk reduction strategies among people who inject drugs

Barriers to practicing risk reduction strategies among people who inject drugs

Toots, tastes and tester shots: user accounts of drug sampling methods for gauging heroin potency

Practices of care among people who buy, use, and sell drugs in community settings

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