Negative Consequences Of Substance Use Research Articles

Lifetime Adversity and Risky Substance Use among Transgender Emerging Adults: Selected Interventions and Clinical Social Work Practice

AbstractThis study investigated multivariate relations between indicators of lifetime adversity and past year risky substance use reported by an Internet-recruited sample of transgender emerging adults from the United States (N = 248, age M = 22.61 years). Canonical correlation analysis (CCA) documented the canonical correlation between canonical variates in this sample (.362), as well as the amount of shared variance (13.1%) between set of variables representing lifetime adversity and past year risky substance use. Examination of the standardized canonical coefficients and structure coefficients highlighted the important contributions of (a) past year drug use and negative consequences of substance use to the synthetic criterion variable and (b) lifetime intimate partner violence to the synthetic predictor variable. Information generated in this study about how specific observed variables contributed to canonical variates may be used to tailor trauma-informed selected interventions in clinical socialwork practice with transgender emerging adults who report substance use problems.

How Should Harm Reduction Be Included in Care Continua for Patients With Opioid Use Disorder?

Practices and interventions that aim to slow progression or reduce negative consequences of substance use are harm reduction strategies. Often described as a form of tertiary prevention, harm reduction is key to caring well for people who use drugs. Evidence-based harm reduction interventions include naloxone and syringe service programs. Improving equitable outcomes for those with opioid use disorder (OUD) requires access to the continuum of evidence-based OUD care, including harm reduction interventions, as well as dismantling policies that undermine mental health and substance use disorder treatment continuity, housing stability, and education and employment opportunities.

Youth participation in substance use prevention: A national profile, 2011–2019

PurposePrevention efforts are critical to avoid the negative consequences of substance use in adolescents. This study aimed to examine national trends and sociodemographic differences in adolescents' participation in school-based substance use prevention (SUP) education, community-based SUP programs, as well as family conversations about substance use. MethodsPublicly available data for adolescents aged 12–17 from the annual cross-sectional surveys of the National Survey on Drug Use and Health 2011–2019 were analyzed. ResultsAcross the survey years, up to 74.9%, 12.2%, and 58.1% of adolescents reported having participated in school-based SUP education, community-based SUP programs, and family conversations about the danger of substance use in the past-year, respectively. From 2011 to 2019, statistically significant decreases were observed in adolescents' participation in school-based SUP education (OR = 0.97, 95% CI: 0.96, 0.98, p < 0.001) and community-based SUP programs (OR = 0.98, 95% CI: 0.97, 0.99, p < 0.001). Meanwhile, no significant changes were observed in adolescents' participation in family conversations about the dangers of substance use. Overall, lower levels of participation in school-based and community-based SUP programs were found in adolescents aged 16–17. Adolescents living in rural areas showed lower levels of participation in school-based SUP programs and family conversations about SUP. Racial/ethnic minority adolescents overall were less likely to participate in conversations with parents about SUP than Whites. ConclusionsFurther development and implementation of developmentally appropriate, gender-specific, culturally sensitive, and contextually informed SUP programs at school, community, and family levels are needed.

Adolescents' perceptions of substance use messaging in the age of social media: resolving cognitive dissonance.

This study interviewed adolescents about their exposure to and perceptions of substance-related social media content and substance use prevention messages. Participants (analytic sample N = 30, age 14-18 years, in CA, USA, 40% male) were recruited from Instagram and Facebook for online semi-structured interviews. An interview transcript coding guide was developed based on the interview questions and emerging themes. Most (27/30) participants reported exposure to peers using substances on social media through posts made on personal accounts. All peer posts portrayed substance use in a positive light. Most participants reported exposure to formal prevention messages on social media (i.e. public service announcements) (19/30) and in schools (i.e. drug education) (21/30; 70.0%) teaching the negative consequences of substance use. Responses to the differences between peer posts and prevention messages included dismissing prevention messages (7/30), believing that their peers were more credible (4/30), desiring comprehensive substance information (3/30) and believing that the no-use message was ineffective for at-risk youth (4/30). Messages shared by peers online significantly contrasted with prevention messages (i.e. public service announcements and drug education). This difference appeared to undermine prevention message credibility. Balanced prevention messages acknowledging the spectrum of risk and reward when using different substances may reduce dissonance and increase engagement.

Understanding how primary care providers report discussing substance use with transgender and gender diverse patients

ObjectivesTo explore how primary care providers report discussing substance use with transgender and gender diverse (TGD) adult patients within the context of discussing gender-affirming interventions. MethodsBetween March and April 2022, in-depth, semi-structured qualitative interviews were conducted with 15 primary care providers who care for TGD patients in the Northeastern US. Thematic analysis was used to analyze interview data and identify themes. ResultsTwo primary themes emerged among providers: 1) placing a focus on harm reduction, emphasizing reducing negative consequences of substance use, and 2) using access to gender-affirming interventions as an incentive for patients to change their substance use patterns. ConclusionsFocusing on harm reduction can emphasize reducing potential adverse outcomes while working with TGD patients towards their gender-affirmation goals. Future research should explore varying approaches to how substance use is discussed with TGD patients, as well as the interpretation of gender-affirming clinical guidelines. Practice implicationsFindings from this study indicate a need for enhancing provider knowledge around the appropriate application of gender-affirming care guidelines. Investing in training efforts to improve gender-affirming care is critical for encouraging approaches that prioritize harm reduction and do not unnecessarily prevent access to gender-affirming interventions.

Facilitated telemedicine for hepatitis C virus: Addressing challenges for improving health and life for people with opioid use disorder.

People who use drugs (PWUD) frequently delay or avoid obtaining medical care in traditional healthcare settings. Through a randomized controlled trial, we investigated facilitated telemedicine for hepatitis C virus (HCV) integrated into opioid treatment programmes. We sought to understand the experiences and meanings of facilitated telemedicine and an HCV cure among PWUD. We utilized purposive sampling to interview 25 participants, 6-40 months after achieving an HCV cure. We interpreted and explicated common meanings of participants' experiences of an HCV cure obtained through facilitated telemedicine. Participants embraced facilitated telemedicine integrated into opioid treatment programmes as patient-centred care delivered in 'safe spaces' (Theme 1). Participants elucidated their experiences of substance use and HCV while committing to treatment for both entities. Facilitated telemedicine integrated into opioid treatment programmes enabled participants to avoid stigma encountered in conventional healthcare settings (Theme 2). Participants conveyed facing negative perceptions of HCV and substance use disorder. Improved self-awareness, acquired through HCV and substance use treatment, enabled participants to develop strategies to address shame and stigma (Theme 3). An HCV cure, considered by PWUD as a victory over a lethal infectious disease, promotes self-confidence, enabling participants to improve their health and lives (Theme 4). Integrating facilitated telemedicine into opioid treatment programmes addresses several healthcare barriers for PWUD. Similarly, obtaining an HCV cure increases their self-confidence, permissive to positive lifestyle changes and mitigating the negative consequences of substance use. In this study of patient involvement, we interviewed patient-participants to understand the meaning of an HCV cure through facilitated telemedicine. Participants from a facilitated telemedicine pilot study provided essential input on the design and outcomes of a randomized controlled trial. Pilot study participants endorsed facilitated telemedicine in a testimonial video. They attended site initiation meetings to guide trial implementation. A Patient Advisory Committee (PAC) ensured that patient participants were active members of the research team.The PAC represented patients' voices through feedback on study procedures. ASustainability Committee supported public involvement in the research process, including educational opportunities, feedback on implementation, and future sustainability considerations.

The utility of the MMPI-3 in predicting substance use related problems in a clinical neuropsychology sample

Assessing for problematic substance use in neuropsychological assessments is crucial for differential diagnosis and attribution of symptom causes. The current investigation examines the utility of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3 in predicting such substance use in a clinical neuropsychology sample. Participants included 208 outpatient neuropsychological examinees. Correlations and risk ratios were calculated for externalizing-psychopathology-related scales and external substance use criteria. Hierarchical regressions examined the incremental prediction of criteria by MMPI-3 externalizing scales above the Substance Abuse (SUB) scale. Results indicate that MMPI-3 externalizing scales are associated with substance-use-related criteria as conceptually expected. Additionally, we report significantly increased risk of experiencing substance-use-related problems at various T score elevations on multiple externalizing scales. Finally, SUB served as the primary predictor of substance-use-related criteria. These findings support the ability of the MMPI-3 to assess for past or current substance use and negative consequences of substance use in a clinical neuropsychology setting.

Pattern of Substance Use among Patients Attending De-Addiction Unit in a Nigerian Tertiary Hospital

Substance use is a growing public health problem and the consequences of substance use disorder are costly to the community. The absence of data on the pattern of substance-use among drug using patients attending the University of Benin Teaching Hospital (UBTH) and other hospitals in south-south Nigeria and the negative consequences of substance use justified the study. Thus, the objectives of the study were to investigate the pattern of substance use, the socio-demographic characteristics and clinical indices associated with drug use among the patients attending the De-Addiction Unit in UBTH. It was a cross-sectional study that obtained data from casefiles of 48 patients. Cannabis was the most frequently used substance (52.1%), followed by alcohol (18.8%), tobacco (16.7%), tramadol (14.6%) and pentazocine (12.5%). Majority of the respondents were males 38 (79.2%), age group 18 to 27 years (75%), singles 38 (79.2%), multiple substance users 34 (70.8%), reported peer pressure influence 35 (72.9%) and reported ‘smoking’ as route of substance use 32 (66.7%). It was observed that prevalence of use of drugs among females was rising. The commonest psychiatric co-morbidity among them was depression 19 (39.6%), followed by bipolar affective disorder 10 (20.8%) and schizophrenia 7 (14.6%). Substance use prevention, treatment and control measures need to pay attention to males and female users, since the prevalence of substance use among female is rising. Such programs must bear in mind the adolescent and young adult age groups and measures to mitigate the use of common substances such as alcohol and cannabis must continue to enjoy priority. During screening/assessment for substance use, a high index of suspicion for comorbidities especially depression is important. Peer group influence and curiosity, which are identified reasons for initiating substance use, may be checked by targeted health education.

Predictors of polysubstance vaping in emerging adults

BackgroundPolysubstance use, which increases the risk for negative consequences of substance use, is common among emerging adults who regularly consume substances by vaping. Examining predictors of polysubstance vaping is crucial for understanding whether this novel form of substance consumption lends itself equally efficaciously to established forms of intervention for smoked substances. ObjectiveThe current study aimed to examine whether modifiable cognitive risk factors for increased vaping in the form of attitudes, expectancies and norms can predict co-use of nicotine and cannabis among vapers over and above the effect of demographics, personality risk factors and anxiety, depression symptoms. MethodsRegular nicotine and cannabis vapers between 18 and 30 years were recruited online in Canada via a Qualtrics panel. Hierarchical binary logistic regression was used to predict membership in a polysubstance or a single substance vaping group. Demographics, personality risk factors, depression and anxiety symptoms were included as predictors in block 1; attitudes, expectancies and perceived norms of vaping were added in block 2. ResultsAttitudes, expectancies and norms predicted polysubstance use over and above the effect of demographics, personality risk factors and anxiety, depression symptoms. Positive expectancies played a uniquely significant role in the prediction of polysubstance vaping. ConclusionsCognitive interventions targeting attitudes, expectancies and norms may be effective in prevention of polysubstance vaping, although positive expectancies appear to be the main unique factor that has an influence above and beyond all other cognitive factors related to vaping. Treatment and prevention programs should put special focus on lowering positive expectancies.

Characteristics and circumstances of cocaine-related completed suicide in Australia, 2000–2021

BackgroundThere has been a substantial global increase in cocaine use and associated harms. The current study aimed to: 1. Determine the case characteristics and circumstances of death of cocaine-related suicide in Australia 2000–2021; and 2. Determine the toxicological profiles of cases. MethodsRetrospective study of cocaine-related death in Australia, 2000–2021, retrieved from the National Coronial Information System (NCIS). Suicide intent was based upon the NCIS code for “Intentional Self-harm”, derived from case circumstances and coroners’ conclusions. Sex comparisons were made for all major variables. ResultsA total of 157 cases were identified, 82.2% male, 79.5% employed, with a mean age of 32.3 years. Concerns for mental health were documented in 65.6%, a previous suicide attempt in 21.0%, a history of substance use treatment and/or negative consequences of substance use in 45.9% and injecting drug use in 14.6%. Manner of death amongst both sexes was predominantly by physical means (82.8%). Written intent was documented in 29.3%. Intense agitation prior to the incident was noted in 28.0% and conflict in 24.8%. The median blood cocaine concentration was 0.060 mg/L (range 0.007–5.500). Other drugs were present in 95.5%, most commonly alcohol (63.1%) with a median concentration of 0.140 g/100 ml. Psychostimulants other than cocaine were present in 31.2%. ConclusionsThe ‘typical’ cocaine-related suicide case was a male, aged in their early thirties, who was highly likely to be employed. The majority of cases used physical means, and a substantial minority were highly agitated and engaged in conflict prior to the fatal incident.

Seeing Through Rose-tinted Glass: Exploring Forms of Self-deception Through Students Substance Usage Beliefs

Recently, there has been increasing growth in the use of substance amongst the youth especially in higher education institutions of Pakistan. Literature indicates the existence of self-deception in substance users through self-reports. However, a dearth of qualitative exploration leads us to investigate self-deception through lived experiences of students who use the substance. The aim of the current study is to explore the phenomenon of self-deception through in-depth semi-structured interviews. Smith et al. (2009) interpretative phenomenological analysis was utilized as a method for data collection. The investigators deployed semi-structured interview guide designed through the interview protocol framework. Four themes that emerged from the data were (i) denial, where users exhibited persistent denial from negative effects of the substance; (ii) overconfidence, an illusionary aspect of substance users through elevated self-esteem; (iii) rationalization, where substance users frequently rationalized their usage through multiple attributions, such as family environment, cultural beliefs and common practices. Moreover; and (iv) awareness about positive and negative consequences of substance use, which highlighted paradoxical nature of substance users that move to and from between negative and positive aspects of substance use. Findings suggest a progressive advancement towards the understanding of the phenomenon of self-deception through its prevalent forms in university students who use the substance.

Addiction-Related Outcomes of Nicotine and Alcohol Co-use: New Insights Following the Rise in Vaping.

Nicotine and alcohol-containing products are some of the most commonly used substances of abuse and are both leading causes of preventable death. These substances also have significant interactions that have additive and, in some cases, multiplicative effects on the health consequences of their use. Thus, to reduce these negative consequences, it is important to understand the abuse liability of nicotine and alcohol in combination, especially in the most relevant use cases among those who are most vulnerable. Specifically, as tobacco cigarette use is continually decreasing, vaping is quickly replacing cigarettes as the primary mode of nicotine use. This pattern is especially true in adolescent populations in which vaping has grown considerably. Particularly concerning is that adolescents are more vulnerable than adults to the negative consequences of substance use. It is therefore imperative to revisit the literature as it relates to the rising state of co-use of vaping products with alcohol. Here, we review the clinical outcomes of nicotine and alcohol co-use as they relate to the abuse liability of each individually. Special attention is paid to adolescent findings, where available, as well as investigations that use nontobacco nicotine products as these may more accurately reflect the more recent trends of co-use. Though nicotine alone has previously been considered a proxy for tobacco and tobacco cigarette use, combustible routes of administration have been decreasing. They are, instead, being replaced by e-cigarettes that do not involve other tobacco constituents and contain additional nonnicotine constituents of their own. Unfortunately, the literature remains limited with regard to e-cigarettes and their interactions with other substances, especially their prevalent co-use with alcohol. This review attempts to discuss the current literature on nicotine and alcohol co-use in the context of the vaping epidemic, predominantly focusing on addiction-related outcomes and why e-cigarette use may be unique.

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings : Harm Reduction in Outpatient Addiction Treatment.

Opioid use disorder (OUD) is increasingly recognized as a chronic, relapsing brain disease whose treatment should be integrated into primary care settings alongside other chronic conditions. However, abstinence from all non-prescribed substance use continues to be prioritized as the only desired goal in many outpatient, primary care–based treatment programs. This presents a barrier to engagement for patients who continue to use substances and who may be at high risk for complications of ongoing substance use such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), superficial and deep tissue infections, and overdose. Harm reduction aims to reduce the negative consequences of substance use and offers an alternative to abstinence as a singular goal. Incorporating harm reduction principles into primary care treatment settings can support programs in engaging patients with ongoing substance use and facilitate the delivery of evidence-based screening and prevention services. The objective of this narrative review is to describe strategies for the integration of evidence-based harm reduction principles and interventions into outpatient, primary care–based OUD treatment settings. We will offer specific tools for providers and programs including strategies to support safer injection practices, assess the risks and benefits of continuing medications for opioid use disorder in the setting of ongoing substance use, promote a non-stigmatizing program culture, and address the needs of special populations with ongoing substance use including adolescents, parents, and families.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06904-4.

Appreciating contributions more than celebrating resilience: Reflections on the disclosure of substance use in Appalachia.

Disclosure of personal substance use often places people who use drugs (PWUD) at risk, both personally and professionally. Yet disclosure can positively influence governmental and organizational policies as well as improve programs meant to serve PWUD. Through numerous autobiographical conversations, six researchers and professionals in their thirties and forties who live in the Appalachian region of the United States examined what it meant for us to discuss our illicit substance use publicly. We examined the limitations of the term "lived experience" and detailed our non-problematic use. Most of us have, at times, experienced negative consequences of substance use, but these consequences are as tied to society's negative responses to substance use as to use itself. When disclosing use, we have often found that others are keen to portray PWUD as resilient, but are less willing to highlight the contributions of PWUD while they are using. We agree that making disclosure more acceptable as well as acknowledging the positive aspects of drug use would alter societal responses to use to be more effective at preventing harm. We conclude by highlighting societal and institutional policy changes that will increase the ability of PWUD to openly disclose use.

The Association between Sociocultural Factors and Substance Use among Haramaya University Students.

All the associated risk factors were not equally responsible for influencing individuals either in alcohol use, khat use, tobacco, or cannabis use. This study attempted to examine sociocultural factors influencing university students in substance use by comparing one with another. A cross-sectional study was carried out. The study used a quantitative approach to collect data from 384 students. Compared with their involvement in khat use, female students were positively influenced in cigarette and hashish use (Adjusted Odds Ratio, AOR = 1.102, 95% CI: 1.056, 1.149) and alcohol use (AOR = 1.066, 95% CI: 1.021, 1.113). The involvement of students in alcohol use (AOR = 0.884, 95% CI: 0.838, 0.932) and cigarettes and hashish use (AOR = 0.909, 95% CI: 0.866, 0.953) were negatively associated with stress related to their academic activities. The involvement of students in alcohol use (AOR = 0.942, 95% CI: 0.906, 0.979) was negatively associated with parental influences; involved in alcohol use (AOR = 0.445, 95% CI: 0.210, 0.941) was negatively associated with the thoughts of considering substances as an energizer. The involvement of students in alcohol use (AOR = 4.980, 95% CI: 1.614, 15.368) was positively associated with peer influences. It was, thus, suggested that the management of Haramaya University should work on creating awareness of the negative consequences of substance use. Concerned professionals, including sociologists, psychologists, and health workers, should work on raising students’ awareness as it was possible to undertake their studies without substance use. Moreover, the university management is strongly recommended to expand recreational centers within the campus. Lastly, Haramaya woreda administration should restrict the availability and accessibility of these substances around the campus.

Validation of a French Translation of the McLean Screening Instrument for Borderline Personality Disorder, Invariance Across Genders, and Association With Depression, Trauma Symptoms, and Substance Use Among University Students.

The present study investigated psychometric properties of a French translation of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD; Zanarini et al., 2003) in a large sample of university students (N = 1,350). A confirmatory factor analysis supported the single-factor structure of the MSI-BPD, and its configural, metric and scalar invariance across gender was established. Internal consistency was high (tetrachoric α = .88; Ω = .88). MSI-BPD scores were significantly correlated to depressive symptoms (r = .57), trauma symptoms (r = .40), negative consequences of substance use (r = .25), and frequency of drug use (r = .11). Finally, 9.5% of the sample reached the clinical cutoff, which is similar to the pooled prevalence for BPD reported in a recent meta-analysis of university students. The present study showed that the French translation of the MSI-BPD is a psychometrically sound screening tool for BPD in both men and women.

Parents' experiences of substance use problems, parenthood, and recovery within the 12-step movement.

Aim:The aim of this study was to explore how people with earlier substance use problems narrated their experiences of becoming and being parents. The literature in this area is limited.Method:The study participants, all active members of the 12-step movement, were interviewed about their experiences of substance use problems, recovery, and parenthood. The data were analysed using a narrative theoretical framework seeking to answer the questions of how the parents narrate their experiences of parenthood within the frame of a classic 12-step storyline and how they present themselves as parents through these narratives.Results:The results show that, on the whole, the narratives conformed to a classic 12-step storyline. For example, the narratives’ turning points were often built up around experiences of “hitting rock bottom”, when the negative consequences of substance use culminated in dramatic events forcing the narrators to see the seriousness of their problems. At the same time the motivational potential of having or expecting (or wishing for future) children was downplayed by several study participants, who instead said that positive driving forces such as human relationships were not enough to break through their denial of their substance use problems. Finally, all study participants described how the process of working towards sobriety had been a transformative experience through which they had come in better contact with their feelings and emotions, and they defined this as an important resource in their everyday lives as parents.Conclusion:The results showed that the parents, when narrating their experiences within the frames of a classic 12-step storyline, were also able to present themselves as competent parents, empowered rather than stigmatised by their earlier experiences.

Negative Consequences of Substance Use in European University Students: Results from Project SNIPE

Background: University students are a risk group for heavy substance use and the experience of various potentially severe negative substance use consequences which may impact on their health, social, and academic functioning. Whilst the experience of negative consequences of substance use is well understood in North American student samples, there is little data on these experiences in European students. In order to develop effective harm prevention and reduction interventions for students’ substance use, there needs to be an understanding of the types of consequences experienced in European student samples. Objectives: The aim of the study was to investigate the prevalence and predictors of the experience of negative substance use-related consequences amongst university students in 7 European countries. Methods: University students (n = 4,482) in Belgium, Denmark, Germany, the Slovak Republic, Spain, Turkey, and the UK completed an online survey of their substance use behaviours and the experience of associated negative consequences. Results: European students reported that experiencing a hangover or illness, missing class, being short of money, and experiencing memory loss were the most commonly experienced negative consequences of substance use. Not living with other students and using alcohol, cannabis, sedatives, and cocaine were also associated with higher odds of experiencing these negative consequences. Conclusions: In contrast to North American data, European university students tended to experience consequences that are associated with lower level health risks rather than more severe consequences (e.g., drink-driving and physical injury). Harm prevention and reduction interventions for students should be targeted towards those consequences that are most salient to the target group to ensure feedback is relevant and potentially more effective in changing students’ substance use behaviours.

Psychosocial Stress and Attitudes Toward Substance Use Among College Students: An Exploratory Study

Substance use occurs on college campuses nationwide and is among the top threats to college-student health. The present study aimed to explore the impact of stress on substance use attitudes. The independent variable was acute psychosocial stress, induced using the Trier Social Stress Test. We measured chronic stress using the Adverse Childhood Experiences questionnaire. The Alcohol Purchase Task (i.e., alcohol demand, alcohol breakpoint, alcohol expenditure) and the Cognitive Appraisal of Risky Events-Revised questionnaire (i.e., expected involvement with substances and expected benefits and consequences of using substances) were the dependent variables. We predicted that participants who completed the acute stress task would report greater attitudes toward substance use behaviors and this would be more pronounced for those with higher levels of chronic stress. Acute stress did not affect willingness to pay for alcohol, F(3, 85) = 0.55, p = .65, ηp2 = 0.02, or expected positive or negative consequences from engaging in substance use, F(3, 85) = 0.44, p = .73, ηp2 = 0.02. There was a small positive association between chronic stress, as measured by adverse childhood experiences, and expected use, ρ(89) = .22, p = .04. In exploratory analyses, we found expected positive benefits of substance use to be significantly associated with expected future involvement, whereas expected negative consequences of substance use was associated with expected future involvement. Our results imply that acute and chronic stress were not significant in predicting substance use behaviors. Rather, those who expect benefits are more likely to use substances.

Looking beyond harm: meaning and purpose of substance use in the lives of marginalized people who use drugs

Substance use among marginalized populations has historically been constructed as a social problem to be managed, cured, and eliminated. Much social science research concerning drug use among marginalized populations focuses on risks and harms, with little attention to positive aspects of substance use. In this paper we explore positive roles of drugs/drug use among marginalized people who use drugs. We draw on in-depth qualitative interviews conducted with 50 people who use drugs in Vancouver’s Downtown Eastside neighbourhood. Forty-three participants reported positive aspects of drug use. Participant narratives revealed four main themes regarding the role and function of drugs and drug use in their lives: (1) pain relief and management; (2) alleviating mental health issues; (3) fostering social experiences; (4) pleasurable embodied experiences. Our findings show that despite known negative consequences of substance use, in many ways drug use was beneficial for these individuals. Our study demonstrates that given the opportunity, meaningful and useful conversations that shed light on why people take drugs is possible. By understanding why marginalized individuals choose to consume the drugs they do we can begin to engage in truly helpful conversations about how to reduce drug-related harm.