Table 2.

Post-analysis organizing system for Kenya heroin shortage rapid assessment, 2010-2011.

Thematic foci	Situational considerations	Landscape
Settings	Pain, desperation and uncertainty set the stage	• Heroin withdrawal
		• Alleviating the pain
		• Seeking emergency medical services and dosed with codeine
		• Finding heroin or some other drug
		• Some “forced” to quit using
Initiating events	Heroin unpredictability	• Challenges in accessing heroin
		• Heroin cost increases (doubles or triples)
		• Heroin quality decreases
Internal reactions	Disruption in drug users patterns: desperation and actions taken	• Lower quality necessitates increased quantity and more direct method of use
		• Change in consumption mode (mainly from smoking to injecting) and drug type
		• Travel back and forth to procure drugs, changes in hotspots, involvement in criminal acts to get drugs
		• Frustration with treatment and health care worker interactions
		• Morbidity related to withdrawal, toxicity, violence, as well as anecdotes of mortality
Actions by heroin users to deal with the situation	Social behavior: positive or negative peer pressure	• Heroin users help each other out/reliance on other users
		• Pooled resources and procurement efforts; dividing up of drugs
		• HIV risk behaviors, namely syringe sharing but some flashblood
		• Experienced injectors helping newer ones
		• Mistrust, competition and accounts of being cheated out of money and drugs
Consequences of heroin users' actions	Public response	• Familial and community response varies (violence, marginalization, support, advocacy)
Coda/return to the present	Heroin market resurgence	• Drug purity returns; accessibility and affordability leads to morbidity (relapse, overdosing)
		• Realization that treatment is lacking
		• Emergence of new injectors whose consumption mode does not return to smoking
		• Renewed or continued drug use linked to social network and lack of opportunity (being idle)