Heroin in Transition Study, UCSF Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, Milberry Union East, 3rd Floor, San Francisco, CA, 94143, USA.
Homeless Youth Alliance, PO Box 170427, San Francisco, CA, 94117, USA.
Harm Reduct J. 2020 Oct 12;17(1):74. doi: 10.1186/s12954-020-00416-w.
West Virginia is a largely rural state with strong ties of kinship, mutual systems of support and charitable giving. At the same time, wealth inequalities are extreme and the state's drug overdose fatality rate stands above all others in the USA at 51.5/100,000 in 2018, largely opioid-related. In recent years, harm reduction services have been active in the state but in 2018 Charleston's needle and syringe program was forced to close. This paper considers the risk environment in which the state's drug-related loss of life, and those attempting to prevent it, exist.
This rapid ethnographic study involved semi-structured interviews (n = 21), observation and video recordings of injection sequences (n = 5), initially recruiting people who inject heroin/fentanyl (PWIH) at the Charleston needle and syringe program. Snowball sampling led the research team to surrounding towns in southern West Virginia. Telephone interviews (n = 2) with individuals involved in service provision were also carried out.
PWIH in southern West Virginia described an often unsupportive, at times hostile risk environment that may increase the risk of overdose fatalities. Negative experiences, including from some emergency responders, and fears of punitive legal consequences from calling these services may deter PWIH from seeking essential help. Compassion fatigue and burnout may play a part in this, along with resentment regarding high demands placed by the overdose crisis on impoverished state resources. We also found low levels of knowledge about safe injection practices among PWIH.
Hostility faced by PWIH may increase their risk of overdose fatalities, injection-related injury and the risk of HIV and hepatitis C transmission by deterring help-seeking and limiting the range of harm reduction services provided locally. Greater provision of overdose prevention education and naloxone for peer distribution could help PWIH to reverse overdoses while alleviating the burden on emergency services. Although essential for reducing mortality, measures that address drug use alone are not enough to safeguard longer-term public health. The new wave of psychostimulant-related deaths underline the urgency of addressing the deeper causes that feed high-risk patterns of drug use beyond drugs and drug use.
西弗吉尼亚州是一个以农村为主的州，这里有着紧密的亲属关系、相互支持的体系和慈善捐赠。与此同时，该州的贫富差距极大，其 2018 年的药物过量死亡率位居全美之首，达到每 10 万人 51.5 例，主要与阿片类药物有关。近年来，该州的减少伤害服务一直很活跃，但 2018 年查尔斯顿的针具和注射器项目被迫关闭。本文考虑了该州与毒品相关的死亡风险环境，以及那些试图预防这些死亡的人所处的环境。
这项快速人种学研究包括半结构化访谈（n=21）、观察和注射序列的视频记录（n=5），最初在查尔斯顿的针具和注射器项目中招募了海洛因/芬太尼注射者（PWIH）。滚雪球抽样使研究小组深入到西弗吉尼亚州南部的周边城镇。还对参与服务提供的个人进行了电话访谈（n=2）。
南西弗吉尼亚州的 PWIH 描述了一个经常不支持、有时甚至敌对的风险环境，这可能会增加药物过量死亡的风险。包括一些急救人员在内的负面经历，以及对因拨打这些服务而遭受惩罚性法律后果的恐惧，可能会阻止 PWIH 寻求必要的帮助。同情疲劳和倦怠，以及对贫困州资源过度依赖的不满，可能在其中起到了一定的作用。我们还发现，PWIH 对安全注射实践的知识水平较低。
PWIH 面临的敌意可能会增加他们药物过量死亡、注射相关伤害以及 HIV 和丙型肝炎传播的风险，因为这会阻止他们寻求帮助，并限制当地提供的减少伤害服务的范围。为 PWIH 提供更多的过量预防教育和纳洛酮用于同伴分发可能有助于他们逆转药物过量，同时减轻急救服务的负担。尽管减少死亡率至关重要，但仅解决药物使用问题的措施不足以保护更长期的公共卫生。新一波与精神兴奋剂相关的死亡事件突显了必须解决导致高危药物使用模式的深层次原因，这些原因超出了毒品和药物使用本身。
