The power of relationships: Implications for safer and unsafe practices among injection drug users

The Adaptation of the Substance Use Stigma Mechanism Scale (SU-SMS) Into Turkish: A Validity and Reliability Study

BACKGROUND

Substance users are among the most highly stigmatized individuals by both the public and health care providers. However, no multidimensional scale for measuring substance use stigma for substance use disorders (SUDs) currently exists in Turkey.

AIMS

The aim of this study was to determine the validity and reliability of the Turkish version of the Substance Use Stigma Mechanism Scale (SU-SMS).

METHOD

The study was conducted at the AMATEM (Alcohol and Substance Addiction Treatment Center Clinic). The sample group of this methodological study consisted of 156 participants with SUDs who met the inclusion criteria. "Social-demographics Questionnaire," "The Substance Use Stigma Mechanism Scale," and "Internalized Stigma of Mental Illness Scale" were used for data collection. In the validity-reliability analysis of the scale, language and content validity, explanatory and confirmatory factor analysis, criterion-concurrent validity, Cronbach's alpha coefficient, item-total score correlation, split-half reliability analysis, and test-retest reliability methods were used.

RESULTS

Using exploratory factor analysis, it was found that the SU-SMS has five factors. Its five-factor structure was confirmed using confirmatory factor analysis. Its Cronbach's alpha coefficient was .828, and factor loading was between .402 and .971. Analyses indicated that each of the factors of the Turkish version of the scale had high internal consistency. The test-retest correlation value was .752, p = .000.

CONCLUSIONS

It was concluded that the Turkish version of the SU-SMS is a reliable and valid instrument for assessing substance use-related stigma in individuals with SUDs.

Social Capital and Social Networks of Hidden Drug Abuse in Hong Kong

Owing to the increasing prevalence of hidden drug abuse in Hong Kong, yet scarce relevant current local research, this study seeks to carry out an in-depth investigation into the experience of hidden drug abusers, paying particular attention to their relevance to social capital and social networks. Seventy-three abusers attending drug treatment programs were interviewed, and a thematic analysis was performed. The results indicate hidden drug abuse is popular in Hong Kong. Apart from the decline of public, large-scale discos and the change of the types of drugs abused to date, one important contributing factor is the drug supply and transaction networks, which are extensive and multilocused, but secretive, with high closure levels. This kind of network is supported by bonding, bridging, and linking social capital as well as by providing convenient supply modes and offering drug abusers psychological comfort and safety. These factors encourage the hidden drug abuse to prevail and allow drug abusers to remain unidentifiable.

Harm Reduction Strategies and Disinhibitors Among Women Who Use Heroin

People who use illicit drugs face significant physical risks in the acquisition, use, and aftermath of their use. This is particularly the case among those who use heroin in view of recent spikes in heroin-associated overdoses, injuries, and deaths. Using a restrictive deterrence framework, we identify the risks that women associate with chronic heroin use and the ways they seek to manage those risks. We also examine psychological and physiological disinhibitors that contribute to women reducing use of risk reduction strategies. We find from the narratives that nearly all of the women initially engaged in specific strategies to manage risk; however, as they continued using the drug, they began to abandon even the simplest of measures. Our findings shed light on the limitations of harm reduction strategies and inform the theoretical tradition of restrictive deterrence and the importance of disinhibitors.

Substance use stigma: Reliability and validity of a theory-based scale for substance-using populations

BACKGROUND

Substance use disorders consistently rank among the most stigmatized conditions worldwide. Thus, substance use stigma fosters health inequities among persons with substance use disorders and remains a key barrier to successful screening and treatment efforts. Current efforts to measure substance use stigma are limited. This study aims to advance measurement efforts by drawing on stigma theory to develop and evaluate the Substance Use Stigma Mechanisms Scale (SU-SMS). The SU-SMS was designed to capture enacted, anticipated, and internalized Substance Use Stigma Mechanisms among persons with current and past substance use disorders, and distinguish between key stigma sources most likely to impact this target population.

METHODS

This study was a cross-sectional evaluation of the validity, reliability, and generalizability of the SU-SMS across two independent samples with diverse substance use and treatment histories.

RESULTS

Findings support the structural and construct validity of the SU-SMS, suggesting the scale was able to capture enacted, anticipated, and internalized stigma as distinct stigma experiences. It also further differentiated between two distinct stigma sources (family and healthcare providers). Analysis of these mechanisms and psychosocial metrics suggests that the scale is also associated with other health-related outcomes. Furthermore, the SU-SMS demonstrated high levels of internal reliability and generalizability across two independent samples of persons with diverse substance use disorders and treatment histories.

CONCLUSION

The SU-SMS may serve as a valuable tool for better understanding the processes through which substance use stigma serves to undermine key health behaviors and outcomes among persons with substance use disorders.

Perceived discrimination and injecting risk among people who inject drugs attending Needle and Syringe Programmes in Sydney, Australia

BACKGROUND

Previous research indicates that stigma and discrimination have negative consequences for both healthcare delivery and for health outcomes of people who inject drugs (PWID). Also important but not as well researched is the association between perceived discrimination and increased engagement in risky behaviours. This research aimed to explore whether perceived discrimination from workers in Needle and Syringe programmes (NSPs) is associated with increased engagement in injecting risk practices such as the sharing of injecting equipment.

METHOD

Convenience sampling was used across eight NSP sites within Western Sydney, Australia. All clients who attended one of the NSPs were eligible to participate.

RESULTS

A total of 236 clients completed the survey. Perceived discrimination from NSP staff was found to be significantly associated with some injecting risk practices. Respondents who reported greater perceived discrimination from NSP staff were significantly more likely to report being injected by someone else after they had injected themselves (OR 1.2, 95%CI 1.1-1.3) and reusing a needle or syringe (OR 1.1, 95%CI 1.0-1.3) in the last month. Although clients reported perceiving more discrimination from general health workers than from NSP workers (12.8 vs. 10.2, t=7.739, df=226, p<0.001), perceived discrimination from general health workers was not associated with increased injecting risk practices.

CONCLUSIONS

The findings of this study suggest that NSP workers need to be aware that although they work in a model that is usually non-judgemental, their clients may still have a heightened sensitivity to discrimination which can then have consequences for on-going engagement in risk practices.

Higher risk of incident hepatitis C virus among young women who inject drugs compared with young men in association with sexual relationships: a prospective analysis from the UFO Study cohort

BACKGROUND

Female injection drug users (IDUs) may report differences in injection behaviours that put them at greater risk for hepatitis C virus (HCV). Few studies have examined these in association with HCV incidence.

METHODS

Longitudinal data from a cohort of 417 HCV-uninfected IDU aged 30 or younger were analysed. Cox proportional hazards was used to model female sex as a predictor of new HCV infection. General estimating equation (GEE) analysis was used to model female sex as a predictor of HCV-associated risk behaviour prospectively.

RESULTS

Women were significantly more likely than men to become infected with HCV during study follow-up (HR 1.4, p<0.05), and were also more likely than men to report high-risk injecting behaviours, especially in the context of sexual and injecting relationships. Sex differences in injecting behaviours appeared to explain the relationship between sex and HCV infection.

CONCLUSIONS

Young women's riskier injection practices lead to their higher rates of HCV infection. Further study on the impact of intimate partnership on women's risk behaviour is warranted.

Injecting practices in sexual partnerships: hepatitis C transmission potentials in a 'risk equivalence' framework

BACKGROUND

Evidence indicates minimal hepatitis C (HCV) sexual transmission risk among HIV negative heterosexual partners. Limited HCV literacy has been demonstrated among people who inject drugs, yet there is a dearth of research exploring perceptions of HCV heterosexual transmission risk among this high risk population.

METHODS

We conducted a qualitative life history study with people who had been injecting drugs for over six years, to explore the social practices and conditions of long-term HCV avoidance. Participants were recruited through London drug services and drug user networks. The sample comprised 10 women and 27 men (n=37), of whom 22 were HCV antibody negative. Participants were aged from 23 to 57 years and had been injecting for 6 to 33 years. Twenty participants were in long term heterosexual partnerships.

FINDINGS

The majority of participants in relationships reported 'discriminate' needle and syringe sharing with their primary sexual partner. Significantly, and in tension with biomedical evidence, participants commonly rationalised syringe sharing with sexual partners in terms of 'risk equivalence' with sexual practices in regard to HCV transmission. Participants' uncertain knowledge regarding HCV transmission, coupled with unprotected sexual practices perceived as being normative were found to foster 'risk equivalence' beliefs and associated HCV transmission potential.

CONCLUSION

HCV prevention messages that 'add on' safe sex information can do more harm than good, perpetuating risk equivalence beliefs and an associated dismissal of safe injecting recommendations among those already practicing unprotected sex.

Understanding the etiology of prescription opioid abuse: implications for prevention and treatment

Although studies on the initiation of substance abuse abound, the body of literature on prescription opioid abuse (POA) etiology is small. Little is known about why and how the onset of POA occurs, especially among high-risk populations. In this study we aimed to fill this important knowledge gap by exploring the POA initiation experiences of 90 prescription opioid abusers currently in treatment and their narrative accounts of the circumstances surrounding their POA onset. This research was conducted within a storyline framework, which operates on the premise that the path to drug abuse represents a biography or a process rather than a static condition. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed. Analyses revealed the presence of four trajectories leading to POA. This study adds to the limited research on POA etiology by not only illuminating the psychosocial factors that contribute to POA onset, but also by situating initiation experiences within broader life processes. The study findings provide crucial insights to policymakers and interventionists in identifying who is at risk for POA, and more important, when and how to intervene most efficaciously.

Gender Differences Among Prisoners With Pre-Incarceration Heroin Dependence Participating in a Randomized Clinical Trial of Buprenorphine Treatment

The primary focus of the current study is to examine whether gender and other baseline characteristics were significantly associated with more severe patterns of drug use. It involves data from 260 male and female pre-release prison inmates with pre-incarceration heroin dependence who enrolled in a randomized clinical trial of prison-initiated buprenorphine. Three outcomes are examined: 1) Lifetime Intravenous drug use; 2) Lifetime number of drugs used; and 3) Heroin use in prison. Regarding lifetime intravenous drug use; race (p = .0001), education (p = .009), age (p = .0001), and psychological treatment (p = .028) were significant. Concerning lifetime number of drugs used; race (p =.0001) and age of first crime (p = .001) were significant. Finally, gender (p = .004), was the only significant variable in terms of using heroin while in prison. All of these differences may have important clinical, treatment, and research implications, which are discussed.

Challenges and opportunities to integrating family members of injection drug users into harm reduction efforts within the Atlantic Canadian context

BACKGROUND

This paper explores injection drug users' (IDUs) relationships with non-drug using family members in order to understand the potential opportunities for, and challenges to, having these family members provide harm reduction services (e.g., clean syringes).

METHODS

The qualitative data for this paper were drawn from a larger study of IDUs' relationships with key individuals in their lives (e.g., friends, family members). Interviews were conducted with 115 IDUs from across Atlantic Canada living in both urban and rural areas.

RESULTS

IDUs report that their relationships with family members are variable and dynamic, often changing over time. IDUs and family members engage in a variety of strategies to protect themselves from the multiple harms associated with drug use. Several strategies of self-protection (e.g., discontinuing all contact) are antithetical to the provision of harm reduction supports by family members. However, other strategies are based on continued contact, providing a potential opportunity for the integration of harm reduction approaches. Some family members not only have contact but provide supports (e.g., emotional support, housing) thus potentially facilitating the integration of harm reduction. In a few instances, family members already provide harm reduction supports (e.g., safe space to use).

CONCLUSIONS

Conceptualizing addictions as a health and social justice issue, and providing appropriate interventions, may reduce some of the harms experienced by users and family members thus encouraging sustained relationships and greater integration of harm reduction approaches into the relationship. Targeted education to family members about harm reduction may also further encourage their involvement in such efforts. Likewise, supporting family members who are already providing harm reduction supports will likely assist in the scaling-up of harm reduction efforts.