Initiation Stories: An Examination of the Narratives of People Who Assist With a First Injection

Abstract

Background: Research in the area of initiation to injection drug use that focuses on the perspective of initiators, or those who help with a first injection, is rare. Objective: To explore the process of initiation to injection drug use from the point of view of initiators. Methods: Semi-structured, in-depth qualitative interviews were conducted at a harm reduction program in Toronto, Canada. Twenty participants who had injected drugs in the last 30 days and who reported ever having initiated another person to injection drug use were recruited. A narrative analytic approach was used to explore the spectrum of narratives surrounding their experiences initiating others to injection drug use. Results: Initiation events arise in a complex interplay of individual circumstances and social contexts. People who inject may assist with a first injection for a variety of reasons, from conceding to social pressure, to wanting to help reduce a perceived risk of harm, to assisting because it provides a sense of pride at possessing a skill or of having helped someone achieve a desired state, to assisting to obtain drugs or to cope with withdrawal, or a mix of several of these reasons at once. Conclusions/Importance: Narratives reveal that preventing all instances of initiation is unrealistic. Combining elements from existing interventions that focus on enhancing reluctance to assist with initiation with safer injection training has the potential to reduce initiations and perhaps reduce injection related harm for novices if initiation occurs.

Keywords :

• initiation
• initiators
• injection drug use
• harm reduction
• narrative analysis
• HIV prevention
• peer injecting

THE AUTHORS

Gillian Kolla, MPH, is a PhD student at the Dalla Lana School of Public Health, University of Toronto. She is interested in the risk environments of people who use drugs, particularly the ways in which structural factors contribute to HCV and HIV risk.

Carol Strike is an Associate Professor at the Dalla Lana School of Public Health in Toronto, ON, Canada. Over the past 20 years, Carol has and continues to investigate harm-reduction programs and policies.

Élise Roy is a public health physician, full professor at the Faculty of medicine and social sciences, University of Sherbrooke. She holds a research chair, la Chaire de recherche en toxicomanie, supported by the foundation of l'Hôpital Charles-Lemoyne. In the past 20 years, she has led several studies based on quantitative and qualitative methods on risk behaviours and blood-borne infections among marginalized drug users. She is mostly involved in research on drug consumption pathways, associated social and health outcomes, and the development and evaluation of innovative interventions in this area. She is principal investigator of a research team on mental health and HIV-HCV risky behaviors among cocaine users. She is also the co-principal investigator of a prospective cohort study on hepatitis C among injection drug users. She is internationally known for her research work on the health of street youth and recognized as a leading expert on initiation into drug injection and R&D on interventions in the field.

Jason Altenberg (MSW) is the Director of Programs and Services at South Riverdale Community Health Centre (SRCHC) in Toronto, Canada. Over the last decade at SRCHC Jason has served as clinical services and urban health manager. Prior to his work at SRCHC, Jason was the Executive Director of a community mental health program and worked as a front line worker in homelessness, mental health, and harm-reduction services in Toronto and Vancouver.

Raffi Balian founded the COUNTERfit Harm Reduction Program, a community-based, drug-user driven project, in 1998. An award-winning activist and advocate for the rights of people who use drugs, he is a member of multiple drug-user organizations and has been involved in several research projects and advisory groups. He is currently the Coordinator of COUNTERfit's Harm Reduction programs.

Rey Silver is a long-time member of COUNTERfit's Harm Reduction program, and has been involved in several peer-led initiatives and harm reduction research projects. He is currently the Organizer of COUNTERfit's Satellite Site program.

Neil Hunt (MSc Social Research) is an Honorary Senior Research Associate at the School of Social Policy, Sociology and Social Research, University of Kent; and, Honorary Research Fellow with the Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, University of London. A founding director of the UK Harm Reduction Alliance, his work has covered issues including injecting and risk, understanding drug trends, peer influence and young people, clubbers’ drug use, human rights, and drug user involvement. He developed the “Break the Cycle” intervention to reduce injecting, which has been disseminated nationally by the Department of Health. He worked on the Joseph Rowntree Foundation's publications on Drug Consumption Rooms and the subsequent development of guidance for their operation in the United Kingdom.