Next steps in research on injection initiation incidence and prevention

Bluthenthal, Ricky N.; Kral, Alex H.

doi:10.1111/add.13001

Cited by 14 publications

(17 citation statements)

References 17 publications

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“…Future research should address the underrepresentation of experiences of particular ethnic, sexual, and gender identities in current research; the role of particular drugs; and identify additional specific pathways linking social and structural factors to individual experiences of injection initiation (10). …”

Section: Discussionmentioning

confidence: 99%

“…Patterns of drug injecting are evolving: injection drug use is increasing in some areas and populations that have historically reported low prevalence (e.g., Sub-Saharan Africa (6), white rural populations in North America (7, 8)). There has long been interest in preventing transitions to drug injecting (9, 10), though the effectiveness of interventions has been limited according to scientific evaluations conducted to date (11). There is therefore a need to further develop understanding of injection drug use initiation to inform interventions and policy responses.…”

Section: Introductionmentioning

confidence: 99%

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The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis

et al. 2017

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Background and aim Understanding the experience of initiating injection drug use and its social contexts is crucial to inform efforts to prevent transitions into this mode of drug consumption and support harm reduction. We systematically reviewed and synthesized existing qualitative scientific literature to identify the socio-structural contexts for, and experiences of, the initiation of injection drug use. Methods We systematically searched six databases (Medline, Embase, PsychINFO, CINAHL, IBSS, and SSCI), along with a manual search, including of key journals and subject experts. Peer-reviewed studies were included if they qualitatively explored experiences of or socio-structural contexts for injection drug use initiation. A thematic synthesis approach was used to identify descriptive and analytical themes across studies. Results From 1731 initial results, 41 studies reporting data from 1996 participants were included. We developed eight descriptive themes and two analytical (higher order) themes. The first analytical theme focused on injecting initiation resulting from a social process enabled and constrained by socio-structural factors: social networks and individual interactions, socialization into drug-using identities, and choices enabled and constrained by social context all combine to produce processes of injection initiation. The second analytical theme addressed pathways that explore varying meanings attached to injection initiation and how they link to social context: seeking pleasure, responses to increasing tolerance to drugs, securing belonging and identity, and coping with pain and trauma. Conclusions Qualitative research shows that injection drug use initiation has varying and distinct meanings for individuals involved and is a dynamic process shaped by social and structural factors. Interventions should therefore respond to the socio-structural influences on injecting drug use initiation by seeking to modify the contexts for initiation, rather than solely prioritizing the reduction of individual harms through behavior change.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis

et al. 2017

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“…Interventions to prevent the initiation of injection drug use: a systematic review Werb et al [18] 2014 BChange the Cycle^intervention Strike et al [19] 2015 Next steps in research on injection initiation incidence and prevention Bluthenthal and Kral [20] 2015 US NIDA Avant Garde Award: BCombined prevention to reduce initiation into injecting drug use^Forthcoming 2015 US NIDA Avenir Award: BPreventing injecting by modifying existing responses^Werb et al [21] 2015 US NIDA R01: BPreventing injection initiation: the Change the Cycle randomized controlled trial^Forthcoming be persistent [36]. Therefore, preventing transitions into injecting should address both the need to prevent people from seeking out injecting and the need to prevent PWID from initiating others into this behavior.…”

Section: Risk Factors For Injection Initiatesmentioning

confidence: 99%

“…Third, preventing injection initiation will require a reconsideration of the key populations for HIV prevention. Specifically, while PWID are implicated in injection initiation events, research to date has delineated those populations at greatest risk of initiating; these should be meaningfully considered within broader prevention efforts [20]. Fourth, a global strategy to prevent injection will necessarily require multisite investigations to determine how best to optimize prevention strategies to local dynamics and discrete policy environments, including low-, middle-, and upper-income settings.…”

Section: Barriers To Effectively Preventing Injection Initiationmentioning

confidence: 99%

Preventing Injection Drug use Initiation: State of the Evidence and Opportunities for the Future

et al. 2017

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“…Adherence to the social communicability of this condition is further influenced by individual, social, and structural factors (Horyniak et al, 2014; Horyniak et al, 2015; Sherman et al, 2002). As such, in settings experiencing syndemics of IDU and blood-borne disease, calls have been made to prioritize the prevention of injection initiation to reduce disease incidence and mitigate other drug-related harms (Bluthenthal & Kral, 2015; Vlahov, Fuller, Ompad, Galea, & Des Jarlais, 2004; Werb et al, 2016). Preventing injection initiation is likely to be more effective in curtailing the expansion of epidemics of blood-borne disease compared with efforts to reduce injection-related risk behaviors among individuals after they have begun injecting, given that the risk of HIV and hepatitis C virus (HCV) transmission increases dramatically during the months and years immediately postinitiation (Garfein, Vlahov, Galai, Doherty, & Nelson, 1996; Vlahov et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Injection Drug Use Trajectories among Migrant Populations: A Narrative Review

Melo

Mittal

Horyniak

et al. 2018

Substance Use & Misuse

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Background Dual epidemics of injection drug use and blood-borne disease, characterized as “syndemics,” are present in a range of settings. Behaviors that drive such syndemics are particularly prevalent among mobile drug-using populations, for whom cross-border migration may pose additional risks. Objectives This narrative review aims to characterize the risk factors for injection drug use initiation associated with migration, employing a risk environment framework and focusing on the San Diego–Tijuana border region as the most dynamic example of these phenomena. Methods Based on previous literature, we divide migration streams into three classes: intra-urban, internal, and international. We synthesized existing literature on migration and drug use to characterize how mobility and migration drive the initiation of injection drug use, as well as the transmission of hepatitis and HIV, and to delineate how these might be addressed through public health intervention. Results Population mixing between migrants and receiving communities and the consequent transmission of social norms about injection drug use create risk environments for injection drug use initiation. These risk environments have been characterized as a result of local policy environments, injection drug use norms in receiving communities, migration-related stressors, social dislocation, and infringement on the rights of undocumented migrants. Conclusion Policies that exacerbate risk environments for migrants may inadvertently contribute to the expansion of epidemics of injection-driven blood-borne disease. Successful interventions that address emerging syndemics in border regions may therefore need to be tailored to migrant populations and distinguish between the vulnerabilities experienced by different migration classes and border settings.

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Next steps in research on injection initiation incidence and prevention

Cited by 14 publications

References 17 publications

The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis

The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis

Preventing Injection Drug use Initiation: State of the Evidence and Opportunities for the Future

Injection Drug Use Trajectories among Migrant Populations: A Narrative Review

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