Qualitative Exploration of Low-Frequency Heroin Injectors Not in Drug Treatment

描述（由申请人提供）：为了更好地了解海洛因注射模式介于戒断和依赖之间，我们建议对未接受美沙酮治疗的低频海洛因注射者进行研究。一般认为，生理依赖和每日多次注射是海洛因使用者的常态。然而，我们的研究显示，在长期的、街头招募的、未接受治疗的海洛因注射者中，17%的人每月只注射1到10次。在20世纪70年代，诺曼·津伯格开创了他所谓的“控制海洛因使用”的研究，并开发了经典的药物，环境和环境框架（DSS）来检查非强迫性药物使用。从那时起，海洛因注射的危害成倍增加，包括艾滋病毒/艾滋病、病毒性肝炎流行病和致命的过量吸毒率上升。需要对低频海洛因注射（low-FHI）有更现代的了解，以帮助了解药物滥用、药物治疗和传染病预防等领域。我们建议对50名低fhi使用者和30名高频海洛因注射者（每日海洛因注射者；“高fhi”）进行定性队列研究。本研究的具体目的如下：目的1：通过检查低和高fhi吸毒者的终生药物使用史和预期1年和2年的药物使用轨迹，探讨海洛因注射频率的转变。目的2：利用决策支持的框架，评估低收入人群的动机和背景，并将其与高收入人群进行比较。目的3：探讨低fhi使用者的药物治疗经历和需求。目的4：探讨影响低fhi使用者中HIV、HCV和药物过量风险的环境因素，并将其与高fhi使用者进行比较。为了实现这些目标，将采用有针对性的抽样方法，招募50名低富营养指数使用者和30名高富营养指数使用者进行队列研究。所有研究参与者将在基线和1年接受深入的定性访谈和成瘾严重程度指数的管理；此外，一半的参与者将在2年后再次接受采访。每月还将从每个参与者收集有关过去一个月的药物使用频率和生活事件（例如，进入治疗，失去住房，监禁）的数据。这些月度数据将为关于海洛因使用变化及其背景的后续访谈提供重要线索。它们还将用于触发简短的定性“状态变化”访谈（n=36）。为了组织和告知我们的调查，我们将使用金伯格经典决策支持系统框架的更新概念模型。定性分析将使用接地理论方法进行。低fhi是药物研究中一个被忽视的领域，对预防和干预具有重大意义。对低fhi的深入评估可以为治疗方法提供信息，并扩大我们关于城市贫困人口海洛因使用变化的知识库。

DESCRIPTION (provided by applicant): To better understand heroin injection patterns that fall between abstinence and dependence, we propose a study of low-frequency heroin injectors who are not in methadone treatment. It is generally assumed that physiological dependence and multiple daily injections are the norm for heroin users. Yet our research has revealed that among long-term, street-recruited, out-of-treatment heroin injectors, 17% inject only 1 to 10 times monthly. In the 1970s, Norman Zinberg pioneered the study of what he termed "controlled heroin use" and developed the classic framework of drug, set, and setting (DSS) to examine noncompulsive drug use. Since that time, the hazards of heroin injection have multiplied to include HIV/AIDS, epidemics of viral hepatitis, and rising rates of fatal overdose. A more contemporary understanding of low-frequency heroin injection (low-FHI) is needed to help inform the fields of substance abuse, drug treatment, and infectious disease prevention. We propose to conduct a qualitative cohort study of 50 low-FHI users and, for comparative purposes, 30 high-frequency heroin injectors (daily heroin injectors; "high-FHI"). Specific aims of the study are the following: Aim 1: To explore transitions in heroin injection frequency by examining lifetime drug use history and prospective 1- and 2-year trajectory of drug use, among low-FHI and high-FHI users. Aim 2: Using the framework of DSS, to assess the motivations and context of low-FHI and compare them with high-FHI. Aim 3: To explore the experiences with and the need for drug treatment among low-FHI users. Aim 4: To explore contextual factors that influence risk for HIV, HCV, and overdose among low-FHI users, and compare them with high-FHI users. To achieve these aims, 50 low-FHI and 30 high-FHI users will be recruited into a cohort study using targeted sampling methods. All study participants will undergo in-depth qualitative interviews and administration of the Addiction Severity Index at baseline and 1 year; in addition, half the participants will be interviewed again at 2 years. Data will also be collected monthly from each participant regarding drug use frequency and life events (e.g., entry into treatment, loss of housing, incarceration) in the past month. These monthly data will provide important cues for follow-up interviews regarding changes in heroin use and their context. They will also be used to trigger brief qualitative "change of status" interviews (n=36). To organize and inform our inquiry, we will use an updated conceptual model of Zinberg's classic DSS framework. Qualitative analysis will be conducted using grounded theory methods. Low-FHI is an overlooked area of drug research with substantial implications for prevention and intervention. An in-depth assessment of low-FHI can inform treatment approaches and expand our knowledge base regarding variations in heroin use among urban poor populations.