Mazhnaya Alyona, Kiriazova Tetiana, Chernova Olena, Tobin Karin, Owczarzak Jill
Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
Ukrainian Institute on Public Health Policy, 5 Biloruska Street, Kyiv 04050, Ukraine.
Int J Drug Policy. 2021 Jan;87:102988. doi: 10.1016/j.drugpo.2020.102988. Epub 2020 Oct 28.
Little research has been conducted in Ukraine since the 1990s to understand the organization of drug market and its implications for people who inject drugs (PWID). In this study, we explore how PWID perceive the retail drug market in a large Ukrainian city. Qualitative data were obtained during in-depth interviews and analyses included open coding, coding tree development and revision, axial coding, and identification of higher-level domains. Participants' narratives focused on types and forms of drugs available, perceptions about drug quality, methods of buying drugs, and the relationships that are formed and maintained by participating in the drug economy. The described technical organization of the drug market, with multiple contingent combinations of drug types, forms and means of obtaining drugs (hand-to-hand vs stash-based) resulted from diversification and digitalization of the retail injection drug market. The social organization of the drug market in the form of relationships with sellers and drug use partners represented the response to the fundamental problem of uncertainty. The lens of ``transaction cost'' helps explain strategies PWID used to manage uncertainties, including finding reliable and suitable sellers, sending money and picking up the stash under the threat of being stiffed or caught by the police, choosing the product itself, using the intermediaries to outsource risky operations and forming groups to procure and inject together. Our results indicate that the technical and social organization of drug distribution in Ukraine stimulates formation and continuation of relationships and impacts the choices of what, how, and when to inject beyond individual preferences. The policy and practice implications include the need to monitor and understand the retail drug market to develop and deliver more efficient and client-oriented services, incorporate and leverage social networks structure for information sharing and behavior change, pilot and implement drug testing services to assist with management of uncertainties.
自20世纪90年代以来，乌克兰开展的旨在了解毒品市场组织及其对注射吸毒者影响的研究很少。在本研究中，我们探讨了注射吸毒者如何看待乌克兰一个大城市的零售毒品市场。通过深入访谈获得了定性数据，分析包括开放编码、编码树的开发与修订、轴心编码以及更高层次领域的识别。参与者的叙述集中在可得毒品的类型和形式、对毒品质量的看法、购买毒品的方法，以及参与毒品经济所形成和维持的关系。所描述的毒品市场技术组织，具有毒品类型、形式和获取毒品方式（面对面交易与藏货点交易）的多种偶然组合，是零售注射毒品市场多样化和数字化的结果。毒品市场的社会组织，表现为与卖家及吸毒伙伴的关系，是对不确定性这一基本问题的应对。“交易成本”视角有助于解释注射吸毒者用来管理不确定性的策略，包括寻找可靠且合适的卖家、在面临被欺骗或被警察抓住的威胁下汇款和取货、选择产品本身、利用中介外包风险操作以及组成团体一起采购和注射。我们的结果表明，乌克兰毒品分销的技术和社会组织促进了关系的形成与延续，并影响了注射吸毒者在毒品选择、方式及时间上的决定，而不仅仅是个人偏好。政策和实践方面的启示包括需要监测和了解零售毒品市场，以开发和提供更高效且以客户为导向的服务；整合并利用社交网络结构进行信息共享和行为改变；试点并实施毒品检测服务以协助管理不确定性。
