Abstract

Background

Considering most people who inject drugs (PWID) received help with the first injection, understanding the perspective of potential ‘initiators’ is a priority to inform harm reduction interventions. This paper examines how PWID narrate their experiences with injection initiation and assistance from the lens of their lived experience and perceptions of harm reduction.

Methods

In-depth interviews were conducted with individuals who reported injection drug use and recent (past 30 days) opioid use in Baltimore (N = 19) and Anne Arundel County (N = 4), Maryland and analyzed using a narrative approach.

Results

Respondents cast initiation events as meaningful transitions to a life characterized by predictable harms, including homelessness, infections, and social stigma. Respondents used examples from their personal experience to explain experiences with initiation and assistance by strategically attributing personal agency and predicting specific injection-related harms for initiates. In their narratives, respondents balanced notions of individual agency with harm reduction intentions by distinguishing between two forms of harm: perceived inevitable distal harm caused by long-term injection (e.g. socioeconomic decline) and potentially avoidable proximal harm caused by risky injection practices (e.g. overdose, HIV).

Conclusions

These findings highlight opportunities for interventions targeting injection initiation events and support the implementation of safer injection training in interventions. This identity of the ‘responsible drug user’ could be leveraged to support employing peers to help mitigate harm among inexperienced PWID either through peer outreach or formal venues, such as overdose prevention sites.

中文翻译：

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“我知道这会毁了他们的生活：”关于注射启动协助的叙述中的算命、代理和减少伤害

摘要

背景

考虑到大多数注射毒品者 (PWID) 在第一次注射时得到帮助，了解潜在“发起者”的观点是为减少危害干预提供信息的优先事项。本文探讨注射吸毒者如何从他们的生活经历和对减少危害的看法的角度讲述他们在注射开始和协助方面的经历。

方法

对在巴尔的摩 ( N  = 19) 和 马里兰州安妮阿伦德尔县 ( N = 4)报告注射吸毒和最近（过去 30 天）阿片类药物使用情况的个人进行了深入访谈，并使用叙事方法进行了分析。

结果

受访者将入会事件视为向以可预测伤害为特征的生活的有意义转变，包括无家可归、感染和社会污名。受访者使用他们个人经验中的例子，通过战略性地归因于个人能动性和预测特定注射相关的伤害，来解释发起和帮助的经历。在他们的叙述中，受访者通过区分两种形式的伤害来平衡个人机构与减少伤害意图的概念：长期注射造成的不可避免的远期伤害（例如社会经济衰退）和风险注射做法造成的潜在可避免的近端伤害（例如过量服用） ， 艾滋病病毒）。

结论

这些发现突出了针对注射起始事件的干预机会，并支持在干预中实施更安全的注射培训。可以利用“负责任的吸毒者”的这种身份来支持雇佣同伴，通过同伴外展或正式场所，例如过量预防场所，帮助减轻没有经验的注射吸毒者的伤害。