People who use drugs, and particularly people experiencing addiction, are rarely afforded the opportunity to have their voices heard when it comes to drug treatment or drug policy or even when attempting to define themselves and their life experiences. Of course, there is much more to a person than one area of their behaviour. The current study seeks to capture and understand the lived experiences of people who use drugs, with a focus on their relationships and helping behaviour. We interviewed 32 participants in a harm reduction program seeking to provide understanding beyond stigmatizing and criminalizing drug narratives, by exploring their motivation and context for helping behaviours. Grounded theory methodology was used to understand the patterns of helping behaviour, along with the contexts in which help is or is not given. We particularly focus on participants' distribution of syringes and carrying medicine to reverse overdose (naloxone). Participants shared stories of altruism and mutual aid, along with barriers and disincentives to helping others. We situate these behaviours within contrasting environments of a free harm reduction program and the competitive market system of the U.S. society. Implications for practice and public policy are discussed.

People who use drugs, and particularly people experiencing addiction, are rarely afforded the opportunity to have their voices heard when it comes to drug treatment or drug policy or even when attempting to define themselves and their life experiences. Of course, there is much more to a person than one area of their behaviour. The current study seeks to capture and understand the lived experiences of people who use drugs, with a focus on their relationships and helping behaviour. We interviewed 32 participants in a harm reduction program seeking to provide understanding beyond stigmatizing and criminalizing drug narratives, by exploring their motivation and context for helping behav- iours. Grounded theory methodology was used to under- stand the patterns of helping behaviour, along with the contexts in which help is or is not given. We particularly focus on participants' distribution of syringes and carrying medicine to reverse overdose (naloxone). Participants shared stories of altruism and mutual aid, along with barriers and disincentives to helping others. We situate these behaviours within contrasting environments of a free harm reduction program and the competitive market system of the U.S. society. Implications for practice and public pol- icy are discussed.