Search results

The purpose of this paper is to investigate a group of Romanian injecting substance users “migrating” from heroin to novel psychoactive substances (NPS) as a counterpublic seeking to escape the stigma of drug abjection.

The findings are drawn from interview and observational data collected mainly at drug services sites in Bucharest, Romania.

The stimulant powders sold by head shops appealed to experienced drug users because they seemed to emulate a consumerist ethos and cultivate a healthy, rational agent that popular discourses of addiction deem incompatible with drug careers. NPS and head shops were thus initially understood as a possibility of escaping “junk identities”. However, they ultimately sealed injectors as abject bodies that obstructed the collaborative goals of rehabilitation and health restoration. A sense of symbolic distance shaped by notions of moral and bodily hygiene separated heroin and NPS users, as the latter increasingly came to be seen and see themselves as flawed consumers of health and freedom.

NPS retail spaces could present valuable opportunities to insert harm-reduction resources and harness counterpublic health strategies.

Dominant definitions of substance use as unavoidable paths into self-destruction push users towards unknown compounds they can attach more fluid meanings to. This suggests that prohibitionist language still obscures rational dialogue about existing and emerging drugs.

The paper traces ATS/NPS in an Eastern European context offering an alternative vantage point to harm-focused perspectives.

Prisoners experience high rates of chronic physical health problems, poor mental health and high rates of substance misuse. However, little is known about what happens to prisoners after release from custody, except that many re‐offend and a disproportionate number die from drug overdose, suicide, accidents and other causes. Using a prospective design, 160 prisoners in Queensland, Australia were interviewed prior to release then 1 and 4 months post‐release. Most prisoners had a history of substance misuse and many reported poor mental health pre‐release. The prevalence of these problems was also high post‐release and there was a high degree of continuity of impairment. These findings add support to calls for (a) population‐level pre‐release planning and post‐release support for prisoners returning to the community, and (b) screening and targeted intervention for those most at risk of poor post‐release outcomes.

The prevalence of older people who use drugs is increasing in many countries, with evidence that some women continue or begin illicit substance use in midlife and older age. While research on older people who use drugs is limited, evidence of risk behaviours among older women who use drugs is particularly inadequate. Unsafe drug use and sexual practices that are prolonged and sustained over many years increase the possibilities for poorer health, leading to potentially greater morbidity and early mortality among older drug users. This chapter is a timely contribution to the extant literature and explores our current knowledge of the risk behaviours of older women who use drugs.

Although midlife is viewed as a transition period in the life course, the normative role expectations of midlife and older women run parallel to the stereotypes of women who use drugs. Furthermore, drug-using bodies are politically and culturally shaped through control and containment practices centred around notions of difference and risk. Acknowledging the intersection of age, race and gender, this chapter frames its position around the concepts of ‘risk’ and ‘edgework’. Utilising these theoretical concepts, this chapter argues that a shift towards a support-focussed model, rather than control of, older women who use drugs is required. The absence of a focussed, gendered analysis of the lives and experiences of older drug users, and older women who use drugs in particular, limits our understanding. Consequently, the chapter concludes with a call for well-designed studies of this increasing and largely hidden cohort of drug users.

Injecting drug use (IDU) has traditionally been seen as a law enforcement problem and a stain on society. With the emergence of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), however, the discourse on IDU has widened to include crucial public health and human rights concerns. Economic analysis, too, has much to contribute to the policy debate. By examining the costs and benefits of drug use from the perspective of injecting drug users, economic analysis can shed light on the problem of IDU and the transmission of HIV among users. This chapter also presents new results on the economic analysis of needle exchange programmes.

This paper aims to explore the cessation of injecting amongst male drug users when in prison in England and uncovers what influenced this behaviour and why.

Qualitative interviews were conducted with 30 male drug users on release from prison to explore what happened to their injecting drug use in prison. The research was conducted from a pragmatic harm reduction approach using grounded theory.

Not injecting in prison was identified as a pertinent finding and nine overarching themes accounted for this decline. The themes often overlapped with one another, highlighting how the decision not to inject when last in prison was multi‐factorial. Running throughout the themes were participants' concerns regarding the health and social risks attributed to injecting in prison, alongside an appreciation of some of the rehabilitative measures and opportunities offered to injecting drug users when in prison.

This qualitative research offers an updated perspective on illicit drug injecting in prison in England from the view of drug users since health and prison policy changes in prescribing and practice. It contributes to evidence suggesting that prisons can be used as a time of reprieve and recovery from injecting drug use.

The purpose of this paper is to explore prison drug injecting prevalence, identify any changes in injecting prevalence and practice during imprisonment and explore views on prison needle exchange.

An empirical prospective cohort survey conducted between 2006 and 2008. The study involved a random sample of 267 remand and sentenced prisoners from a large male category B prison in England where no prison needle exchange operates. Questionnaires were administered with prisoners on reception and, where possible, at one, three and six months during their sentence.

In total, 64 per cent were injecting until admission into prison. The majority intended to stop injecting in prison (93 per cent), almost a quarter due to the lack of needle exchange (23 per cent). Yet when hypothetically asked if they would continue injecting in prison if needle exchange was freely available, a third of participants (33 per cent) believed that they would. Injecting cessation happened on prison entry and appeared to be maintained during the sentence.

Not providing sterile needles may increase risks associated with injecting for prisoners who continue to inject. However, providing such equipment may prolong injecting for other prisoners who currently cease injecting on account of needle exchange programmes (NEPs) not being provided in the UK prison setting.

Not providing sterile needles may increase risks associated with injecting for prisoners who continue to inject. However, providing such equipment may prolong injecting for other prisoners who currently cease injecting on account of NEPs not being provided in the UK prison setting.

This survey is the first to question specifically regarding the timing of injecting cessation amongst male prisoners and explore alongside intention to inject should needle exchange facilities be provided in prison.

The purpose of this paper is to explore how injecting opiate users on a methadone treatment programme experience stigma as drug addicts, and as service users in health care and pharmacy settings. In particular the paper explores the rationale for injecting drugs, which the paper is argued to create the conditions for experiencing shame at the micro interactional level, influenced by macro institutional factors. The paper links this issue of being an injecting drug user in treatment to question whether the definition of recovery as “drug free” in the Scottish drug policy document The Road to Recovery (2008) creates the potential for stigma of service users receiving methadone maintenance treatment.

In all, 14 participants, all of whom identified themselves as problem intravenous users of drugs, were recruited from three voluntary sector (third sector) treatment agencies in Scotland. Participants took part in semi-structured interviews; these were recorded, transcribed and qualitatively analysed thematically.

Participants describe feelings of stigma in relation to their drug taking as problem users. Their experiences as recovering opiate injectors raises further challenges in distancing themselves from stigmatised addict identities.

Reasons for injecting rather than smoking heroin were principally financially challenging a widely held belief that users inject primarily for pleasure, which is argued as increasing the potential for stigma. Shame and perceived discrimination was documented before and during drug treatment.

The purpose of this paper is to examine patterns of drug use among a cohort of drug treatment-seeking drug-using gay men and other men who have sex with men (MSM), and whether these activities differ between, or predict, HIV status.

Cross-sectional study was conducted in a specialist club drug clinic in London covering 407 consecutive attendees who identified as MSM. Substance use, including injecting drug use (IDU), associated sexual activity and self-reported HIV status were measured by clinical interview and National Drug Treatment Monitoring System data tool.

Over a 45-month period, 407 MSM attended the clinic. In total, 62.1 per cent were HIV positive, 48.9 per cent had injected drugs, 14.9 per cent reported needle sharing and 73.3 per cent used drugs to facilitate sex. The most commonly reported problem drugs were GHB/GBL (54.3 per cent) methamphetamine (47.7 per cent) and mephedrone (37.8 per cent). HIV status was associated with methamphetamine, mephedrone, IDU, sharing equipment, using drugs to facilitate sex, older age and older age of drug initiation, as well as Hepatitis C virology (HCV) status. Use of methamphetamine, HCV infection, older age and IDU predicted HIV positive status in a logistic regression model.

The findings describe a constellation of risk factors including high levels of IDU, sharing of equipment and high-risk sexual activity in a population with high rates of HIV positive serology. They also provide further evidence for a link between HIV infection and use of methamphetamine.

The authors suggest a need for greater awareness of HIV-related risk activities and promotion of HIV prevention strategies for MSM by both sexual health and drug treatment services.

This paper is amongst the very first studies of its nature.

The purpose of this study is to explore the contextual determinants of HIV risk among people who inject drugs (PWID) in public settings in Nigeria.

In-depth, individual interviews were conducted with 29 street-based PWID recruited through snowball sampling in Uyo, Nigeria. Interviews were tape-recorded, transcribed, coded and analysed hematically.

Homelessness and withdrawal pains encouraged consumption of drugs in public spaces (e.g. bunks, public parks). Conversely, the benefits of participation in street drug-use scenes, including reciprocity norms that guarantee free drugs during withdrawal and protection during overdose, fostered a preference for public injecting. Although participants recognized the need to inject with sterile syringes, scarcity of syringes compelled them to improvise with old syringes or share syringes, increasing risk for HIV transmission. HIV risk was exacerbated by unlawful and discriminatory policing practices, which deterred possession of syringes and encouraged risky behaviours such as rushing injection and sharing of equipment.

Contextual factors are key determinants of HIV risk for street-based PWID. Implementation of needle and syringe programmes as well as reforming legal frameworks and policing practices to support harm reduction are needed responses.

This is one of very few qualitative studies that explore risk factors for HIV transmission among PWID in West Africa. The focus on scarcity of sterile syringes and HIV risk is unique and has important policy implications.