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Article
Publication date: 14 June 2013

Charlotte N.E. Tompkins

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.

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

International Journal of Prisoner Health, vol. 9 no. 2
Type: Research Article
ISSN: 1744-9200

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Article
Publication date: 1 March 2008

L. F. Moller, B. J. Van Den Bergh, S. Karymbaeva, A. Esenamanova and R. Muratalieva

In Kyrgyzstan the prevalence of injecting drug behaviour is among the highest found throughout the world. Health promotion training, improved health care and…

Abstract

In Kyrgyzstan the prevalence of injecting drug behaviour is among the highest found throughout the world. Health promotion training, improved health care and needle/syringe exchange (NSE) programmes have been shown to decrease risk behaviour among injecting drug users. In Kyrgyzstan, an intervention study with training of prison staff and prisoners was performed in one prison. Before and after the training, a random selection of the prisoners answered a questionnaire about drug use, risk behaviour and health care. The survey was carried out in both the intervention prison and in a reference prison. The number of drug users, the use of drugs and risk behaviour were improved significantly within half a year and, especially, the injection and use of drugs decreased in the intervention group. The study clearly shows that increased focus, improved healthcare and training of prisoners and staff on drug use and harm reduction can reduce both use of drugs and risk behaviour.

Details

International Journal of Prisoner Health, vol. 4 no. 3
Type: Research Article
ISSN: 1744-9200

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Book part
Publication date: 23 September 2005

David E. Bloom, Ajay Mahal and Brendan O’Flaherty

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…

Abstract

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.

Details

Substance Use: Individual Behaviour, Social Interactions, Markets and Politics
Type: Book
ISBN: 978-1-84950-361-7

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Article
Publication date: 11 December 2020

Ediomo-Ubong Ekpo Nelson and Macpherson Uchenna Nnam

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.

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Practical implications

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.

Originality/value

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.

Details

Drugs and Alcohol Today, vol. 20 no. 4
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 29 November 2013

Iain McPhee, Anne Brown and Colin Martin

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

Drugs and Alcohol Today, vol. 13 no. 4
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 16 March 2015

Nat M.J. Wright, Charlotte N. E. Tompkins and Tracey M. Farragher

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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.

Originality/value

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.

Details

International Journal of Prisoner Health, vol. 11 no. 1
Type: Research Article
ISSN: 1744-9200

Keywords

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Article
Publication date: 6 March 2017

Owen Bowden-Jones, Claire Whitelock, Dima Abdulrahim, Stacey Hemmings, Alexander Margetts and Michael Crawford

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Practical implications

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.

Social implications

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.

Originality/value

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

Details

Drugs and Alcohol Today, vol. 17 no. 1
Type: Research Article
ISSN: 1745-9265

Keywords

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Article
Publication date: 14 March 2016

Anak Agung Sagung Sawitri, Anak Agung Gede Hartawan, Noel Craine, Ayu Kartika Sari, Ni Wayan Septarini and Dewa Nyoman Wirawan

– The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia.

Abstract

Purpose

The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia.

Design/methodology/approach

A cross-sectional survey of inmates of using a structured questionnaire and sample framework to reflect narcotic use among inmates and the prison gender mix.

Findings

Among 230 inmates recruited to the study self-reported prevalence of injecting drug use was 7.4 percent (95 percent CI 4.0-10.8percent). Respondents who participated in a prison based methadone treatment program were all still injecting drugs, these made up 13/17 of the IDU. In total, 47 percent (95 percent CIs 45-55 percent) of respondents who reported injecting also reported sharing needles within the last week. Sexual intercourse while in prison was reported by 3.0 percent (95 percent CI 0.82-5.26 percent) of study respondents. One-third of non-injectors were unaware of the preventative role of condom use. This study suggests that despite harm reduction initiatives within Kerobokan prison HIV risk behavior continues and there is a considerable lack of awareness of the importance of condom use in preventing HIV.

Research limitations/implications

The authors relied on self-reported risk behavior that may be subject to reporting bias. The sampling strategy may not reflect the true ratio inmates using or not using narcotics.

Practical implications

The current harm reduction approach, including methadone substitution treatment should be optimized within the Indonesian prison setting.

Originality/value

This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program.

Details

International Journal of Prisoner Health, vol. 12 no. 1
Type: Research Article
ISSN: 1744-9200

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Article
Publication date: 1 February 2009

C. N. E. Tompkins, N. M. J. Wright, M. G. Waterman and L. Sheard

The United Kingdom Ministry of Justice recently highlighted the extent of buprenorphine (Subutex) misuse in English andWelsh prisons, naming it the third most misused drug

Abstract

The United Kingdom Ministry of Justice recently highlighted the extent of buprenorphine (Subutex) misuse in English andWelsh prisons, naming it the third most misused drug overall. Yet little is known regarding how illicit buprenorphine is obtained in prison and what influences prisoners to use it. Qualitative research was used to explore prison drug using practices. Thirty men who were former prisoners with a history of injecting drug use were interviewed in depth about their illicit prison drug use, including buprenorphine. Interviews were conducted over 18 months, from August 2006 to January 2008 and were analysed using Framework. The misuse of Subutex by snorting emerged as a significant theme. Accounts suggested that the diversion of prison prescribed Subutex was widespread and prisoners used various tactics to obtain the medication. Various complex and interlinked reasons were given to explain why Subutex was snorted in prison. The main motivation for snorting was to experience a prolonged euphoric opiate effect, believed to help to combat the boredom of being in prison. The price of illicit Subutex in prison was linked to its availability, but it was generally cheaper than heroin, thus contributing to its use. Participants’narratives identified the belief that snorting Subutex in prison was not risk free, but risks were lower than continuing to use other drugs, particularly injecting illicit opiates. The implications of prison Subutex misuse for prisoners, prison medical services, commissioners, and prescribing policy and practice are discussed.

Details

International Journal of Prisoner Health, vol. 5 no. 2
Type: Research Article
ISSN: 1744-9200

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Article
Publication date: 1 March 2007

Charlotte N. E. Tompkins, Joanne Neale, Laura Sheard and Nat M. J. Wright

Imprisonment is common among drug users. However, historically healthcare for injecting drug users in prison in England and Wales has not been equivalent to that offered…

Abstract

Imprisonment is common among drug users. However, historically healthcare for injecting drug users in prison in England and Wales has not been equivalent to that offered in community settings. Fiftyone injecting drug users who had a history of imprisonment were interviewed. Interviews focused on the experiences of drug‐related care and treatment in prison. The interviews were analysed using the Framework method. Accounts of prison drug treatment experiences provided valuable insights into drug treatment in the English prison. The participants’ accounts provided a historical perspective, many of which reflected the different practices of different prisons and prison staff and the changes in policy and practice that have occurred in prison healthcare over recent decades. Positive and negative experiences of healthcare and drug treatment in prison were discussed. Issues that affected levels of drug use inside prisons and their receipt of care, support and treatment in prison included prescribing policies, illicit drug availability and prison staff and doctor attitudes. Whilst negative experiences of prison and drug treatment prevailed, users identified that recent policy and practice changes had positively influenced healthcare provision for drug users in prison, particularly the provision of opiate maintenance therapy. Drug users often saw prison as an opportunity to detoxify and contemplate their drug use. Further work needs to build on the positive experiences identified to ensure that prison drug treatment in England and Wales is consistent, effective and efficient in the future.

Details

International Journal of Prisoner Health, vol. 3 no. 3
Type: Research Article
ISSN: 1744-9200

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