Syvertsen Jennifer L, Paquette Catherine E, Pollini Robin A
The Ohio State University, Department of Anthropology, 4046 Smith Laboratory, 174 W. 18th Ave., Columbus, OH 43210, USA.
Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Beltsville, MD 20705, USA.
Int J Drug Policy. 2017 Jun;44:41-49. doi: 10.1016/j.drugpo.2017.03.003. Epub 2017 Apr 27.
Injection drug use initiation represents a critical point of public health intervention, as injection increases risk for blood borne infections including Hepatitis C and HIV. In this paper, we explore pathways to injection initiation among youth (≤30) in the rural context of California's Central Valley, where rates of injection drug use are among the highest in the nation.
We draw on semi-structured qualitative interviews with 20 young injectors to examine drug use histories, including the factors that participants associated with their transition to injection drug use.
The average age was 24.7 years (range: 20-30), 45% were female (n=9), and 30% were Latino (n=6). Participants described a variety of pathways to injection, culminating in a first injection that involved either opioids (n=12) or methamphetamine (n=8). Among the opioid group, the majority used prescription opioids before transitioning to injection, while a smaller number transitioned to opioid injection from non-opioid recreational drug use. Injectors who first used prescription opioids often described growing up in affluent suburban areas and transitioned to injection with peers, owing to a combination of factors related to individual tolerance, cost, and shifting drug markets. In contrast, methamphetamine initiates grew up in less affluent families with histories of substance use that exposed them to drugs at an early age. Methamphetamine users transitioned from smoking and snorting to injection, often with family members or intimate partners, within broader contexts of social disadvantage and stress.
While much of the focus on young injectors has centred on the current opioid epidemic, our data suggest a need to consider multiple pathways towards injection initiation of different drugs. Targeted interventions addressing the unique injection transition contexts of both opioids and methamphetamine are urgently needed in the Central Valley of California.
开始注射吸毒是公共卫生干预的一个关键点，因为注射会增加包括丙型肝炎和艾滋病毒在内的血源性感染风险。在本文中，我们探讨了加利福尼亚中央谷地农村地区青少年（≤30岁）开始注射吸毒的途径，该地区的注射吸毒率在全国名列前茅。
我们对20名年轻注射吸毒者进行了半结构化定性访谈，以研究吸毒史，包括参与者认为与他们转向注射吸毒相关的因素。
平均年龄为24.7岁（范围：20 - 30岁），45%为女性（n = 9），30%为拉丁裔（n = 6）。参与者描述了多种开始注射吸毒的途径，最终首次注射涉及阿片类药物（n = 12）或甲基苯丙胺（n = 8）。在阿片类药物组中，大多数人在转向注射之前使用处方阿片类药物，而少数人从非阿片类娱乐性药物使用转向阿片类药物注射。最初使用处方阿片类药物的注射吸毒者通常描述自己在富裕的郊区长大，并因与个人耐受性、成本和不断变化的毒品市场相关的多种因素，与同龄人一起转向注射吸毒。相比之下，甲基苯丙胺吸毒者成长于不太富裕的家庭，有吸毒史，这使他们在早年就接触到毒品。甲基苯丙胺使用者从吸烟和吸食转为注射，通常是与家庭成员或亲密伴侣一起，处于更广泛的社会劣势和压力背景下。
虽然对年轻注射吸毒者的关注大多集中在当前的阿片类药物流行上，但我们的数据表明，需要考虑不同药物开始注射吸毒的多种途径。加利福尼亚中央谷地迫切需要针对阿片类药物和甲基苯丙胺独特的注射转变情况进行有针对性的干预。
