학술논문

Trajectories of initiation for the heroin-based drug whoonga – qualitative evidence from South Africa
Document Type
article
Source
Subject
Social Work
Human Society
Clinical Research
Substance Misuse
Pediatric
Drug Abuse (NIDA only)
Behavioral and Social Science
Prevention
Brain Disorders
2.3 Psychological
social and economic factors
Aetiology
Mental health
Good Health and Well Being
Adolescent
Alcoholism
Heroin
Heroin Dependence
Humans
Illicit Drugs
Male
South Africa
Substance Abuse
Intravenous
Opiate
opioid
nyaope
cannabis
recreational use of antiretroviral medication
HIV
Medical and Health Sciences
Studies in Human Society
Psychology and Cognitive Sciences
Substance Abuse
Public health
Policy and administration
Language
Abstract
BackgroundWhoonga is a smoked heroin-based street drug that first emerged in South Africa a decade ago. While previous scientific reports suggest that use is growing and youth are particularly vulnerable, trajectories of initiation are not well characterized.MethodsIn 2015, 30 men undergoing residential addiction treatment for this smoked heroin drug in KwaZulu-Natal, South Africa participated in semi-structured interviews about their experiences using the drug. Interview data were coded using qualitative content analysis.ResultsParticipant trajectories to initiating smoked heroin were "vertical" in the context of marijuana use or "horizontal" in the context of other hard drug use. Participants reporting vertical trajectories began smoking heroin as youth at school or in other settings where people were smoking marijuana. Several participants with horizontal trajectories started smoking heroin to address symptoms of other drug or alcohol addiction. Social influences on initiation emerged as an overarching theme. Members of participants' social networks who were smoking or distributing heroin figured prominently in initiation narratives. Surprisingly, references to injection drug use were absent from initiation narratives. Participants reported people who smoke heroin differ from those who inject heroin by race.ConclusionConsistent with theories implicating social and structural influences on substance use initiation, people who started smoking heroin had social contacts who smoked heroin and frequented places where substance use was common. Smoked heroin initiation for several participants with horizontal trajectories may have been averted if they accessed evidence-based treatments for stimulant or alcohol use disorders. With increasing reports of heroin use across Africa, a coordinated approach to address this growing epidemic is needed. However, because smoked heroin and injection heroin use occur in distinct risk environments, interventions tailored to people who use smoked heroin will be needed to prevent smoked heroin use, prevent transition to injection use, and mitigate other social harms.