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

– Guise A, Horyniak D, Melo J, McNeil R, Werb D

Importance of this Study:

  • Qualitative research shows that starting to inject drugs has a range of distinct meanings pleasure, increasing tolerance, securing belonging, coping with pain – and is shaped by the environments in which people live.

  • Whilst quantitative studies can explore relationships between individual, social and structural factors, they are less appropriate for addressing the ‘why’ questions underpinning these relationships.

Key Concepts

Qualitative research offers unique insights by enabling in-depth exploration of how injection drug use is experienced. A synthesis of this qualitative literature helps identify the complex pathways by which individual experiences and contexts combine.

How This Study Was Conducted

  • We systematically searched for research in this area, and synthesized the different results to produce themes that give insight in to why people start to inject drugs.

Public Health Implications

Understanding the experience of initiating injection drug use and the social contexts of this phenomenon is crucial to inform efforts to prevent transitions into this mode of drug consumption and support harm reduction.

What This Study Found

  • Our first finding focuses on starting to inject drugs as a process (not a ‘one off’ event) enabled and constrained by broader environmental factors: the social networks people live in, processes of ‘socialization’ into drug-using identities, and the limiting role of ‘macro’ social forces, such as your neighbourhood and poverty.

  • The second set of findings focused on identifying four distinct ‘pathways’ which explore what starting to inject drugs means for individuals involved, and then how this experience is linked to the context in which people live. We found four pathways: seeking pleasure, responses to increasing tolerance to drugs, securing belonging and identity, and coping with pain and trauma.

Key Findings

  • We conclude that 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 and policies should respond to the socio-structural influences on injecting drug use initiation by trying to change the contexts for initiation, rather than solely prioritizing the reduction of individual harms through behavior change.

A global, evidence-based approach on drug use.


© 2019 PRIMER