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ID: HR19-144

Presenting author: Michelle Olding

Presenting author biography:

Michelle Olding is a Research Assistant with the BC Centre on Substance Use (BCCSU) and a doctoral student in the Interdisciplinary Studies Graduate Program at the University of British Columbia (UBC). Her research uses ethnographic methods to investigate how socio-structural factors shape the implementation of overdose prevention interventions.

Injection initiation assistance as harm reduction during a fentanyl-driven overdose crisis: Injection drug users’ experiences and implications for structural interventions

Michelle Olding, Andy Guise, Dan Werb, Ryan McNeil

Aim: Despite the proliferation of fentanyl in North America, the impacts of these drug market changes on injection initiation processes have not been examined. An understanding of the dynamic between drug supply and injection initiation norms will help inform interventions to prevent injection initiation, which are imperative to reducing transmission of HIV and HCV. We explore how people who inject drugs (PWID) in Vancouver, Canada navigate social norms of initiating others into injecting within the context of a fentanyl-driven overdose crisis.

Methods: Between January and April 2017, interviews were conducted with 19 PWID who reported helping someone inject for the first time. Participants were recruited from two cohort studies enrolling HIV-positive and HIV-negative people who inject drugs.

Findings: PWID articulated moral dilemmas about assisting others with injecting. Participants described injection initiation assistance as a prohibited practice. However, narratives of participants’ own participation in injection initiation assistance suggested that the permissibility of this practice was not static, but rather negotiated in relation to socially-situated expectations around practicing inter-personal responsibility. Changes to the drug supply stemming from the proliferation of fentanyl heightened participant’s feelings of moral culpability and criminal liability in the event that an overdose occurred. These concerns existed in tension with protecting novice injectors from harms associated with an increasingly potent and unpredictable drug supply by providing injection assistance and supervision. Assisting novice injectors was therefore seen as a form of harm reduction to prevent them from using alone or engaging in riskier injection practices.

Conclusions: Efforts to prevent transitions to injection drug use must be balanced with ensuring novice injectors have access to safer injecting environments. Structural interventions reducing vulnerability of novice injectors should be prioritized, including the implementation of supervised injection sites allowing for assisted injection, Good Samaritan laws, and policy changes conducive to a safer drug supply.