‘It's more about the heroin’: injection drug users' response to an overdose warning campaign in a Canadian setting

Authors

  • Thomas Kerr,

    Corresponding author
    1. British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
    2. Department of Medicine, University of British Columbia, Vancouver, BC, Canada
    • Correspondence to: Thomas Kerr, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6. E-mail: uhri-tk@cfenet.ubc.ca

    Search for more papers by this author
  • Will Small,

    1. British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
    2. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
    Search for more papers by this author
  • Elaine Hyshka,

    1. British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
    2. Addiction and Mental Health Research Lab, School of Public Health, University of Alberta, Edmonton, AB, Canada
    Search for more papers by this author
  • Lisa Maher,

    1. The Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, NSW, Australia
    Search for more papers by this author
  • Kate Shannon

    1. British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
    2. Department of Medicine, University of British Columbia, Vancouver, BC, Canada
    Search for more papers by this author

  • The copyright line for this article was changed on 21 July 2015 after original online publication.

Abstract

Aims

To assess heroin injectors' perceptions of and responses to a warning issued by public health officials regarding high-potency heroin and increases in fatal overdoses.

Design

Semi-structured qualitative interviews.

Setting

Vancouver, Canada.

Participants

Eighteen active heroin injectors.

Measurements

Semi-structured interview guide focussing on heroin injectors' perceptions of and responses to the overdose warning, including reasons for failing to adhere to risk reduction recommendations.

Findings

Although nearly all participants were aware of the warning, their recollections of the message and the timing of its release were obscured by on-going social interactions within the drug scene focussed on heroin quality. Many injection drug users reported seeking the high potency heroin and nearly all reported no change in overdose risk behaviours. Responses to the warning were shaped by various social, economic and structural forces that interacted with individual behaviour and undermined efforts to promote behavioural change, including sales tactics employed by dealers, poverty, the high cost and shifting quality of available heroin, and risks associated with income-generating activities. Individual-level factors, including emotional suffering, withdrawal, entrenched injecting routines, perceived invincibility and the desire for intense intoxication also undermined risk reduction messages.

Conclusions

Among heroin injectors in British Columbia, a 2011 overdose warning campaign appeared to be of limited effectiveness and also produced unintended negative consequences that exacerbated overdose risk.

Ancillary