Boyd Jade, Fast Danya, Hobbins Megan, McNeil Ryan, Small Will
British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Harm Reduct J. 2017 Jun 5;14(1):31. doi: 10.1186/s12954-017-0159-9.
Injection drug use is associated with HIV and hepatitis C transmission, overdose, and other preventable harms. These harms are heightened for structurally vulnerable injection drug-using populations, as their social conditions pose barriers to safer injecting. Previous research on injection cessation has largely focused on adult drug-using populations. Little qualitative work has examined the social, structural, and environmental factors that shape periods of injection cessation among youth and young adults. Such research is essential to understanding how we can best reduce harms among this vulnerable population as they move in and out of periods of injection cessation.
We conducted 22 semi-structured, qualitative interviews with street-involved young people who use drugs (SY), focused on characterizing their transitions into periods of injection cessation and perceived barriers to injection cessation. Adopting an ethno-epidemiological approach, participants who had experienced at least 6 months of injection cessation were purposively recruited from an ongoing prospective cohort study of SY in Vancouver, Canada to participate in qualitative interviews. Qualitative interview findings were triangulated with the findings of a longitudinal program of ethnographic research with SY in this setting. This ethno-epidemiological approach allowed for a more robust exploration of contextual factors surrounding drug use patterns than would be possible through traditional epidemiological methods alone.
Findings indicate that periods of injection cessation were influenced by access to harm reduction-informed youth-focused services, transitions in route of administration (e.g., from injecting methamphetamine to the smoking of methamphetamine), and the provision of housing and social supports (e.g., from friends, family, and care providers). Conversely, participants indicated that inadequate social supports and, for some, abstinence-focused treatment methods (e.g., 12-step programs), impeded efforts to cease injecting.
To reduce harms, it is imperative to reorient attention toward the social, structural, and spatial contexts that surround injection drug use and shape periods of injection cessation for SY. There is an urgent need for more comprehensive youth-focused services for those engaged in injection drug use, and further study of innovative means of engaging youth.
注射吸毒与艾滋病毒和丙型肝炎传播、药物过量及其他可预防的危害相关。对于在结构上处于弱势的注射吸毒人群而言，这些危害更为严重，因为他们的社会状况给更安全的注射行为带来了障碍。此前关于停止注射的研究主要集中在成年吸毒人群。很少有定性研究探讨影响青少年和青年停止注射阶段的社会、结构和环境因素。此类研究对于理解如何在这一弱势群体进出停止注射阶段时，最大程度地减少危害至关重要。
我们对涉足街头的吸毒青年（SY）进行了22次半结构化定性访谈，重点是描述他们进入停止注射阶段的转变过程以及停止注射所感知到的障碍。采用民族流行病学方法，从加拿大温哥华一项正在进行的SY前瞻性队列研究中，有目的地招募了至少经历过6个月停止注射的参与者，以参与定性访谈。定性访谈结果与在此背景下对SY进行的民族志研究纵向项目结果进行了三角互证。这种民族流行病学方法比仅通过传统流行病学方法更能深入探究围绕吸毒模式的背景因素。
研究结果表明，停止注射阶段受到以下因素影响：获得以减少危害为导向的针对青年的服务；给药途径的转变（例如，从注射甲基苯丙胺转变为吸食甲基苯丙胺）；住房和社会支持的提供（例如，来自朋友、家人和护理提供者）。相反，参与者表示社会支持不足，而且对一些人来说，以禁欲为重点的治疗方法（例如12步戒毒计划）阻碍了停止注射的努力。
为减少危害，必须将注意力重新转向围绕注射吸毒以及影响SY停止注射阶段的社会、结构和空间背景。迫切需要为注射吸毒者提供更全面的以青年为重点的服务，并进一步研究吸引青年的创新方式。
