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) |