“When You're Getting High… You Just Don't Want to Be Around Anybody.” A Qualitative Exploration of Reasons for Injecting Alone: Perspectives from Young People Who Inject Drugs

Winiker, Abigail K.; Tobin, Karin E.; Gicquelais, Rachel E.; Owczarzak, Jill; Latkin, Carl A.

doi:10.1080/10826084.2020.1790008

Cited by 25 publications

(32 citation statements)

References 35 publications

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“…Most participants reported using alone in their rooms. This finding is supported by research documenting that using drugs alone is common [32][33][34][35]. For instance, a recent study of harm reduction service clients from 22 communities across BC found 75.8% of people reported using drugs alone in the previous week [34].…”

Section: Discussionmentioning

confidence: 84%

Overdose Prevention and Housing: a Qualitative Study Examining Drug Use, Overdose Risk, and Access to Safer Supply in Permanent Supportive Housing in Vancouver, Canada

et al. 2022

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The majority of overdose deaths in British Columbia (BC) occur among people using illicit substances alone in private residences. Some supportive housing in BC includes on-site access to a variety of health and substance use–related services. More recently, a number of supportive housing locations have started offering prescribed safer supply medications to people at high overdose risk, though these remain limited and under-evaluated. In this study, we describe the drug use practices — including access to and use of on-site supervised consumption, OAT, and prescribed safer supply medications — of study participants living in permanent supportive housing with integrated primary care, substance use treatment services, and supervised consumption spaces. Qualitative interviews were conducted with 30 residents of a permanent supportive housing site in Vancouver, Canada. Data were analyzed using a sequential process to identify both a priori (e.g., low-barrier substance use treatment, pandemic effects on service access) and emerging themes (e.g., using alone). Most ( N = 27) study participants reported using alone in their rooms, despite having access to an on-site supervised consumption area. Reasons for using alone include the following: preference for being alone, discretion/stigma, and restrictive housing policies. Less than half ( N = 12) of the study participants accessed on-site prescribed safer supply medications. Participants receiving on-site prescribed safer supply described positive benefits including reduced use of illicit opioids, and less reliance on illicit income generation activities. On-site prescribed safer supply programs within supportive housing environments are an important tool in addressing overdose risk.

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Section: Discussionmentioning

confidence: 84%

Overdose Prevention and Housing: a Qualitative Study Examining Drug Use, Overdose Risk, and Access to Safer Supply in Permanent Supportive Housing in Vancouver, Canada

et al. 2022

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“…As well, many of our participants struggled with social alienation, and described a shift over time to using opioids alone, which is a significant known risk factor for opioid overdose [ 62 , 63 ], particularly in Toronto, where most overdose deaths have occurred when people were by themselves in their own homes [ 14 ]. Participant reasons for using alone developed in complex ways and mirrored findings of other research on solo opioid use, where a lack of trust in peers, or shame over drug use or the amount of drug used, drove them to avoid using opioids with others [ 64 ]. Participants praised naloxone and the existence of overdose prevention sites, including the unsanctioned Moss Park overdose prevention site, as effective harm reduction interventions.…”

Section: Discussionmentioning

confidence: 97%

“…Most overdose deaths in Toronto have occurred in private dwellings, and slightly more than half while the person is alone [ 14 ]. A lack of social network, shame, withdrawal symptoms, and financial circumstances can all push people to use opioids alone, even when the dangers of doing so are well-understood [ 64 ]. A recent intervention to introduce naloxone training into single-room occupancy hotels in Vancouver helped engage tenants who used opioids and felt isolated, but poor building conditions, stigma from building managers, and criminalization of opioid use acted as barriers to implementation [ 62 ].…”

Section: Introductionmentioning

confidence: 99%

“They’re not doing enough.”: women’s experiences with opioids and naloxone in Toronto

Macleod

Tajbakhsh

Hamilton‐Wright

et al. 2021

Subst Abuse Treat Prev Policy

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Background Amid increasing opioid overdose deaths in Canada since 2010 and a changing naloxone access landscape, there is a need for up-to-date research on Canadian women’s experiences with opioids. Studies on Canadian take-home naloxone programs are promising, but research beyond these programs is limited. Our study is the first to focus on women’s experiences and perspectives on the opioid crisis in Ontario, Canada’s most populous province, since the opioid crisis began in 2010. Objective Our objective was to address research knowledge gaps involving Canadian women with criminal justice involvement who use opioids, and identify flaws in current policies, responses, and practices. While the opioid overdose crisis persists, this lack of research inhibits our ability to determine whether overdose prevention efforts, especially involving naloxone, are meeting their needs. Methods We conducted semi-structured, qualitative interviews from January to April 2018 with 10 women with experience of opioid use. They were recruited through the study’s community partner in Toronto. Participants provided demographic information, experiences with opioids and naloxone, and their perceptions of the Canadian government’s responses to the opioid crisis. Interviews were transcribed verbatim and inductive thematic analysis was conducted to determine major themes within the data. Results Thematic analysis identified seven major concerns despite significant differences in participant life and opioid use experiences. Participants who had used illicit opioids since naloxone became available over-the-counter in 2016 were much more knowledgeable about naloxone than participants who had only used opioids prior to 2016. The portability, dosage form, and effects of naloxone are important considerations for women who use opioids. Social alienation, violence, and isolation affect the wellbeing of women who use opioids. The Canadian government’s response to the opioid crisis was perceived as inadequate. Participants demonstrated differing needs and views on ideal harm reduction approaches, despite facing similar structural issues surrounding stigma, addiction management, and housing. Conclusions Participants experienced with naloxone use found it to be useful in preventing fatal overdose, however many of their needs with regards to physical, mental, and social health, housing, harm reduction, and access to opioid treatment remained unmet.

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“…This is significant in the context of an ongoing and escalating overdose crisis. While there is limited research on the practice of injecting drugs alone, past work suggests that stigma and shame surrounding drug use may motivate PWID to inject alone, despite the known risks [ 1 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous research suggests that many people who inject drugs (PWID) inject alone and do so for several reasons: to avoid sharing drugs and injection equipment; for privacy, convenience, and comfort; to reduce the potential for assault, robbery, and intimate partner violence; as a result of a preference to inject at home; as a result of frequent disruptions in social networks; and shame and stigma surrounding drug use [ 1 , 17 , 30 , 33 , 39 , 46 ]. Despite a high concentration of harm reduction services in Vancouver, BC, including those in supportive housing settings [ 20 , 33 , 34 ] and accessible virtually [ 27 ], a majority of unregulated overdose deaths take place among people who use drugs (PWUD) alone and indoors, including in private market and supportive housing, shelters, single-room occupancy (SROs) and other hotels [ 5 ], [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Injecting drugs alone during an overdose crisis in Vancouver, Canada

et al. 2022

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Background Settings throughout Canada and the USA continue to experience crises of overdose death due to the toxic unregulated drug supply. Injecting drugs alone limits the potential for intervention and has accounted for a significant proportion of overdose deaths, yet the practice remains understudied. We sought to examine the practice of injecting alone among people who inject drugs (PWID) in Vancouver, Canada. Methods Data were derived from two prospective cohorts of people who use drugs between June 2016 and November 2018. This analysis was restricted to participants who, in the previous 6 months, reported any injection drug use. Rates of injecting alone were categorized as always, usually, sometimes, or occasionally. We fit a multivariable generalized linear mixed model to identify factors associated with injecting drugs alone. Results Among 1070 PWID who contributed 3307 observations, 931 (87%) reported injecting alone at least once during the study period. In total, there were 729 (22%) reports of always injecting alone, 722 (21.8%) usually, 471 (14.2%) sometimes, 513 (15.5%) occasionally, and 872 (26.4%) never. In a multivariable model, factors positively associated with injecting drugs alone included male sex (adjusted odds ratio [AOR] 1.69; 95% confidence interval [CI] 1.20–2.37), residence in the Downtown Eastside neighbourhood (AOR 1.43; 95% CI 1.08–1.91), binge drug use (AOR 1.36; 95% CI 1.08–1.72), and experiencing physical or sexual violence or both (AOR 1.43; 95% CI 1.00–2.03). Protective factors included Indigenous ancestry (AOR 0.71; 95% CI 0.52–0.98) and being in a relationship (AOR 0.30; 95% CI 0.23–0.39). Conclusion We observed that injecting alone, a key risk for overdose mortality, was common among PWID in Vancouver. Our findings underline the need for additional overdose prevention measures that are gender-specific, culturally appropriate, violence- and trauma-informed, and available to those who inject alone.

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“When You're Getting High… You Just Don't Want to Be Around Anybody.” A Qualitative Exploration of Reasons for Injecting Alone: Perspectives from Young People Who Inject Drugs

Cited by 25 publications

References 35 publications

Overdose Prevention and Housing: a Qualitative Study Examining Drug Use, Overdose Risk, and Access to Safer Supply in Permanent Supportive Housing in Vancouver, Canada

Overdose Prevention and Housing: a Qualitative Study Examining Drug Use, Overdose Risk, and Access to Safer Supply in Permanent Supportive Housing in Vancouver, Canada

“They’re not doing enough.”: women’s experiences with opioids and naloxone in Toronto

Injecting drugs alone during an overdose crisis in Vancouver, Canada

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