Death Holds No Fear: Overdose Risk Perceptions Among People Who Inject Drugs

Drug overdose is an important public health problem. Despite well-known risk factors and various preventive measures, the overdose mortality rate has increased substantially in several countries worldwide over the past decade. There is therefore a need to understand overdoses on the basis of how people who inject drugs (PWID) perceive and experience risk. Based on qualitative interviews with 80 PWID recruited from low-threshold settings in Norway, this study explores the complex lived experiences and perceptions of overdose. The qualitative approach is sensitive towards lived experiences and provides new understandings of overdoses. The analysis revealed three types of accounts concerning perceived overdose risk. First, interviewees described death as natural and not frightening, based on perceptions of death as universal, a part of their high-risk lifestyle and their previous overdose experiences. Second, they presented accounts of how they perceived others to be at greater risk of overdose than themselves, in respect of experience, skills and tolerance. Finally, interviewees described an indifference towards death, on a continuum between the wish to live and death as relief from various life challenges. This study illustrates how PWID inhabit drug-using environments which entail a high-risk lifestyle. Faced with these risks, the interviewees presented stories which may serve several functions, such as neutralizing feelings of risk and stigma and gaining a sense of agency and control. They also created symbolic boundaries in order to form positive perceptions of self, by distancing themselves from other stereotypical people who use drugs. The participants additionally expressed an indifference towards overdose death. This may entail that avoiding death, the main rationale of overdose interventions, is viewed with indifference by some PWID. This is important for understanding the complexity of overdose mortality and should be reflected in future harm-reduction initiatives

“Hooked on the needle”: Exploring the paradoxical attractions towards injecting drug use

Injecting drug use is one of the leading risk factors for infections and drug-related deaths. Despite these risks, many people who inject drugs (PWID) continue to inject despite access to alternative intake methods. In this study, we explore this seemingly paradoxical attraction. We conducted 80 qualitative interviews with PWID, recruited from low threshold settings in five Norwegian cities, where we focuson the process of injection initiation and why PWID maintain such behaviour over time, despite associated negative consequences. The analysis shows how participants’ experiences evolved from a fear of the needle, to embracing it as a meaningful practice. First, this involved social interaction and learning from other PWID, second, appreciating the intensity and speed of the intoxication, third, the positive ritual aspect of injecting, and finally, a devaluation of other modes of use. The study thereby helps expand upon and provide new understandings of the interactional process and cultural context of drug use, in which the interplay of social factors influences individual actions and promotes injecting over other modes of use. Future interventions for reducing the number of PWID thus need to consider how various social contexts impinge on, or even encourage, injecting drug use

Which illicit drugs are injected in Oslo? A study based on analysis of drug residues in used injection equipment and self-reported information

Background People who inject drugs (PWID) have a high risk of premature death due to fatal overdoses. Newly emerged fentanyls, much more potent than heroin and other opioids, may increase this risk further. Therefore, precise information on injected drugs is critical to improving prevention strategies. Aims This study aimed to analyse drug residues in used injection equipment in order to determine drug and drug combinations and compare and complement findings with self-reported information. Methods Used syringes and needles ( n=766) were collected at the supervised drug consumption facilities, the needle exchange service and two low-threshold health services for problem drug users in Oslo, Norway. The material was collected every third month from June 2019 to June 2020 and analysed for 64 substances using highly specific analytical methods (ultra–high performance liquid chromatography tandem mass spectrometry). Additionally, a street-recruited sample of PWID was interviewed from 2017 to 2019 regarding their drug injection habits ( n=572). Results Heroin (65.5%) or amphetamines (59.8%), often in combination (30.5%), were commonly detected in drug residues. Other opioids, stimulants or benzodiazepines were rarely detected (6.1%). Fentanyl was detected in only one syringe. Heroin was the most reported drug (77.6% during the past four weeks, 48.3% daily/almost daily), followed by amphetamines (57.5% during the past four weeks, 23.1% daily or almost daily). Injection of methadone, buprenorphine and dissolved tablets was self-reported more frequently than determined in drug residue findings. Conclusions Analysis of the injection equipment proved useful as a non-invasive, rapid and accurate means to obtain detailed information on injected drugs in Oslo and supplement traditional PWID survey information