Abstract
BackgroundEthnic Vietnamese injecting drug users (IDUs) in Australia draw on a range of beliefs and etiologic models, sometimes simultaneously, in order to make sense of health and illness. These include understandings of illness as the result of internal imbalances and Western concepts of disease causation including germ/pollution theory.MethodsObservational fieldwork and in-depth interviews were conducted between 2001 and 2006 in neighbourhoods characterised by high proportions of Asian background IDUs and street-based drug markets. Eligibility criteria for the study were: 1) ethnic Vietnamese cultural background; 2) aged 16 years and over and; 3) injected drugs in the last 6 months.ResultsParticipants commonly attempted to treat heroin overdose by withdrawing blood (rút máu) from the body. Central to this practice are cultural beliefs about the role and function of blood in the body and its relationship to illness and health. Participants' beliefs in blood were strongly influenced by understandings of blood expressed in traditional Chinese and Vietnamese medicine. Many participants perceived Western drugs, particularly heroin, as "hot" and "strong". In overdose situations, it was commonly believed that an excessive amount of drugs (particularly heroin) entered the bloodstream and traveled to the heart, making the heart work too hard. Withdrawing blood was understood to reduce the amount of drugs in the body which in turn reduced the effects of drugs on the blood and the heart.ConclusionThe explanatory model of overdose employed by ethnic Vietnamese IDUs privileges traditional beliefs about the circulatory, rather than the respiratory, system. This paper explores participants' beliefs about blood, the effects of drugs on blood and the causes of heroin overdose in order to document the explanatory model of overdose used by ethnic Vietnamese IDUs. Implications for overdose prevention, treatment and management are identified and discussed.
Highlights
Opioid overdose is the leading cause of premature death among heroin users [1]
Unlike opioid overdose cases nationally which occur in private settings, opioid overdoses in the study site (South Western Sydney or SWS) typically occur in public settings [12]
Following Kleinman [21], we sought to explore beliefs about blood, the effects of drugs on blood and the causes of heroin overdose in order to document the explanatory model of overdose used by ethnic Vietnamese injecting drug users (IDUs) in Sydney, Australia
Summary
Opioid overdose is the leading cause of premature death among heroin users [1]. A meta-analysis of longitudinal studies of opioid users found a mortality rate 13 times greater than age and gender-matched peers [2]. Several factors appear to place ethnic Vietnamese injecting drug users (IDUs) at increased risk of fatal opioid overdose [9]. Most participants in the current study were single, unemployed males aged in their late 20s and early 30s, with a history of recent imprisonment These are factors previously identified as being associated with fatal overdose [1,4]. Ethnic Vietnamese injecting drug users (IDUs) in Australia draw on a range of beliefs and etiologic models, sometimes simultaneously, in order to make sense of health and illness. These include understandings of illness as the result of internal imbalances and Western concepts of disease causation including germ/pollution theory
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