Tyree Griffin A, Mosery Nzwakie, Closson Elizabeth F, Mabude Zonke, du Toit Carol, Bangsberg David R, Safren Steven A, Mayer Kenneth H, Smit Jennifer A, Mimiaga Matthew J, Grelotti David J
University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, United States.
MatCH Research Unit (MRU), Department of Obstetrics and Gynaegology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, Suite 1108-9, Commercial City, Durban, KwaZulu-Natal 4001, South Africa.
Int J Drug Policy. 2020 Aug;82:102799. doi: 10.1016/j.drugpo.2020.102799. Epub 2020 Jun 12.
Whoonga is a smoked heroin-based street drug that first emerged in South Africa a decade ago. While previous scientific reports suggest that use is growing and youth are particularly vulnerable, trajectories of initiation are not well characterized.
In 2015, 30 men undergoing residential addiction treatment for this smoked heroin drug in KwaZulu-Natal, South Africa participated in semi-structured interviews about their experiences using the drug. Interview data were coded using qualitative content analysis.
Participant trajectories to initiating smoked heroin were "vertical" in the context of marijuana use or "horizontal" in the context of other hard drug use. Participants reporting vertical trajectories began smoking heroin as youth at school or in other settings where people were smoking marijuana. Several participants with horizontal trajectories started smoking heroin to address symptoms of other drug or alcohol addiction. Social influences on initiation emerged as an overarching theme. Members of participants' social networks who were smoking or distributing heroin figured prominently in initiation narratives. Surprisingly, references to injection drug use were absent from initiation narratives. Participants reported people who smoke heroin differ from those who inject heroin by race.
Consistent with theories implicating social and structural influences on substance use initiation, people who started smoking heroin had social contacts who smoked heroin and frequented places where substance use was common. Smoked heroin initiation for several participants with horizontal trajectories may have been averted if they accessed evidence-based treatments for stimulant or alcohol use disorders. With increasing reports of heroin use across Africa, a coordinated approach to address this growing epidemic is needed. However, because smoked heroin and injection heroin use occur in distinct risk environments, interventions tailored to people who use smoked heroin will be needed to prevent smoked heroin use, prevent transition to injection use, and mitigate other social harms.
“翁加”是一种以烟熏海洛因为基础的街头毒品，十年前首次出现在南非。虽然此前的科学报告表明其使用正在增加，且年轻人尤其易受影响，但起始轨迹尚未得到很好的描述。
2015年，南非夸祖鲁 - 纳塔尔省30名因吸食这种烟熏海洛因而接受住院成瘾治疗的男性参与了关于他们使用该毒品经历的半结构化访谈。访谈数据采用定性内容分析法进行编码。
吸食烟熏海洛因的参与者起始轨迹在吸食大麻的背景下是“纵向的”，在使用其他硬性毒品的背景下是“横向的”。报告纵向轨迹的参与者在青少年时期于学校或其他人吸食大麻的场所开始吸食海洛因。几名有横向轨迹的参与者开始吸食海洛因是为了缓解其他毒品或酒精成瘾的症状。社会对起始的影响成为一个总体主题。参与者社交网络中吸食或分销海洛因的成员在起始叙述中占据显著位置。令人惊讶的是，起始叙述中没有提及注射吸毒。参与者报告称，吸食海洛因的人与注射海洛因的人在种族上有所不同。
与暗示社会和结构因素对物质使用起始有影响的理论一致，开始吸食海洛因的人有吸食海洛因的社会联系人，且常去物质使用普遍的场所。如果几名有横向轨迹的参与者能够获得针对兴奋剂或酒精使用障碍的循证治疗，或许可以避免他们开始吸食烟熏海洛因。随着非洲各地海洛因使用报告的增加，需要采取协调一致的方法来应对这一日益严重的流行病。然而，由于吸食烟熏海洛因和注射海洛因发生在不同的风险环境中，需要针对吸食烟熏海洛因者量身定制干预措施，以预防吸食烟熏海洛因、防止转向注射使用，并减轻其他社会危害。
