Abstract
To assess heroin injectors' perceptions of and responses to a warning issued by public health officials regarding high-potency heroin and increases in fatal overdoses. Semi-structured qualitative interviews. Vancouver, Canada. Eighteen active heroin injectors. Semi-structured interview guide focussing on heroin injectors' perceptions of and responses to the overdose warning, including reasons for failing to adhere to risk reduction recommendations. Although nearly all participants were aware of the warning, their recollections of the message and the timing of its release were obscured by on-going social interactions within the drug scene focussed on heroin quality. Many injection drug users reported seeking the high potency heroin and nearly all reported no change in overdose risk behaviours. Responses to the warning were shaped by various social, economic and structural forces that interacted with individual behaviour and undermined efforts to promote behavioural change, including sales tactics employed by dealers, poverty, the high cost and shifting quality of available heroin, and risks associated with income-generating activities. Individual-level factors, including emotional suffering, withdrawal, entrenched injecting routines, perceived invincibility and the desire for intense intoxication also undermined risk reduction messages. Among heroin injectors in British Columbia, a 2011 overdose warning campaign appeared to be of limited effectiveness and also produced unintended negative consequences that exacerbated overdose risk.
Highlights
The health sequelae of heroin use are severe, and include fatal and non-fatal overdose [1]
Many of participants were aware of the overdose warning that had been issued 2 weeks prior to the interviews, some reported first hearing about it in the last 2 days, while others reported hearing about it weeks or months earlier
Consistent with the risk environment framework [14], a diverse set of social, economic and structural forces appeared to interact with individual perceptions and behaviours to overwhelm the messages advocating risk reduction contained in the warning
Summary
The health sequelae of heroin use are severe, and include fatal and non-fatal overdose [1]. A small minority of IDU reported actively seeking out the strong heroin described in the stories, leading Miller to conclude that ‘media reporting of killer batches of heroin has little value as a public health strategy’. This latter finding is consistent with a quantitative study by Freeman et al [6], which found that 21% of drug users in New Jersey, USA, had sought out fentanyl despite warnings of a spike in overdoses associated with use of the drug
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