. 2018 May:55:51-60.

doi: 10.1016/j.drugpo.2018.02.009. Epub 2018 Mar 7.

A fragmented code: The moral and structural context for providing assistance with injection drug use initiation in San Diego, USA

Andy Guise¹, Jason Melo², Maria Luisa Mittal³, Claudia Rafful⁴, Jazmine Cuevas-Mota², Peter Davidson², Richard S Garfein², Dan Werb⁵

Affiliations

¹ Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA; School of Population Health and Environmental Sciences, King's College London, London, SE1 1UL, UK.
² Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA.
³ Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA; School of Medicine, Universidad Xochicalco, Alamar Sur 4850, Chapultepec Alamar, 22110 Tijuana, Baja California, Mexico.
⁴ Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA; School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA.
⁵ Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, Toronto, Ontario, Canada. Electronic address: dwerb@ucsd.edu.

PMID: 29524733
PMCID: PMC5970953
DOI: 10.1016/j.drugpo.2018.02.009

A fragmented code: The moral and structural context for providing assistance with injection drug use initiation in San Diego, USA

Andy Guise et al. Int J Drug Policy. 2018 May.

. 2018 May:55:51-60.

doi: 10.1016/j.drugpo.2018.02.009. Epub 2018 Mar 7.

Authors

Andy Guise¹, Jason Melo², Maria Luisa Mittal³, Claudia Rafful⁴, Jazmine Cuevas-Mota², Peter Davidson², Richard S Garfein², Dan Werb⁵

Affiliations

¹ Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA; School of Population Health and Environmental Sciences, King's College London, London, SE1 1UL, UK.
² Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA.
³ Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA; School of Medicine, Universidad Xochicalco, Alamar Sur 4850, Chapultepec Alamar, 22110 Tijuana, Baja California, Mexico.
⁴ Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA; School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA.
⁵ Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, Toronto, Ontario, Canada. Electronic address: dwerb@ucsd.edu.

PMID: 29524733
PMCID: PMC5970953
DOI: 10.1016/j.drugpo.2018.02.009

Abstract

Background: Injection drug use initiation is shaped by social networks and structural contexts, with people who inject drugs often assisting in this process. We sought to explore the norms and contexts linked to assisting others to initiate injection drug use in San Diego, USA, to inform the development of structural interventions to prevent this phenomenon.

Methods: We undertook qualitative interviews with a purposive sample of people who inject drugs and had reported assisting others to initiate injection (n = 17) and a sub-sample of people who inject drugs (n = 4) who had not reported initiating others to triangulate accounts. We analyzed data thematically and abductively.

Results: Respondents' accounts of providing initiation assistance were consistent with themes and motives reported in other contexts: of seeking to reduce harm to the 'initiate', responding to requests for help, fostering pleasure, accessing resources, and claims that initiation assistance was unintentional. We developed analysis of these themes to explore initiation assistance as governed by a 'moral code'. We delineate a fragmented moral code which includes a range of meanings and social contexts that shape initiation assistance. We also show how assistance is happening within a structural context that limits discussion of injection drug use, reflecting a prevailing silence on drug use linked to stigma and criminalization.

Conclusions: In San Diego, the assistance of others to initiate injection drug use is governed by a fragmented moral code situated within particular social norms and contexts. Interventions that address the social and structural conditions shaped by and shaping this code may be beneficial, in tandem with efforts to support safe injection and the reduction of injection-related harms.

Keywords: Drug use; Injection drug use; Injection initiation assistance; North America; People who inject Drugs.

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Conflict of interest statement

Conflicts of interest: none.

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References

1. Anderson E. Code of the Street. New York: W.W. Norton & Company; 1999.
1. Armenta RF, Roth AM, Wagner KD, Strathdee SA, Brodine SK, Cuevas-Mota J, Garfein RS. Prevalence and Correlates of the Use of Prefilled Syringes Among Persons Who Inject Drugs in San Diego, CA. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2015;92(6):1081–1091. doi: 10.1007/s11524-015-9988-6. - DOI - PMC - PubMed
1. Blankenship KM, Friedman SR, Dworkin S, Mantell JE. Structural Interventions: Concepts, Challenges and Opportunities for Research. Journal of Urban Health. 2006;83(1):59–72. doi: 10.1007/s11524-005-9007-4. - DOI - PMC - PubMed
1. Bluthenthal RN, Wenger L, Chu D, Quinn B, Thing J, Kral AH. Factors Associated with Initiating Someone into Illicit Drug Injection. Drug and Alcohol dependence. 2014;144:186–192. doi: 10.1016/j.drugalcdep.2014.09.008. - DOI - PMC - PubMed
1. Bourgois P. The moral economies of homeless heroin addicts: confronting ethnography, HIV risk, and everyday violence in San Francisco shooting encampments. Subst Use Misuse. 1998;33:2323–2351. - PubMed

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A fragmented code: The moral and structural context for providing assistance with injection drug use initiation in San Diego, USA

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A fragmented code: The moral and structural context for providing assistance with injection drug use initiation in San Diego, USA

Authors

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