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之间的禁欲和依赖，我们提出了一项研究的低频海洛因注射者谁不是在美沙酮治疗。一般认为，生理依赖和每天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、治疗结束的海洛因注射者中，17%的人每月只注射1到10次。在20世纪70年代，诺曼·津伯格（Norman Zinberg）率先研究了他所谓的“受控海洛因使用”，并开发了经典的药物，设置和设置（DSS）框架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过量率上升。需要对低频率海洛因注射（low-FHI）有更现代的理解，以帮助告知药物滥用，药物治疗和传染病预防领域。我们建议进行定性队列研究的50个低FHI用户，并为比较的目的，30个高频海洛因注射器（每日海洛因注射器，“高FHI”）。本研究的具体目的如下：目的1：通过检查低FHI和高FHI使用者的终生药物使用史和预期的1年和2年药物使用轨迹，探索海洛因注射频率的转变。目的2：使用决策支持系统的框架，评估低家庭健康保险的动机和背景，并将其与高家庭健康保险进行比较。目的3：探讨低FHI使用者的药物治疗经验和需求。目的4：探讨影响低FHI使用者中HIV、HCV和药物过量风险的背景因素，并将其与高FHI使用者进行比较。为了实现这些目标，50低FHI和30高FHI用户将被招募到一个队列研究使用有针对性的抽样方法。所有研究参与者将在基线和1年时接受深入的定性访谈和成瘾严重程度指数管理;此外，一半的参与者将在2年时再次接受访谈。还将每月从每名参与者收集关于药物使用频率和生活事件的数据（例如，进入治疗，失去住房，监禁）在过去的一个月。这些月度数据将为有关海洛因使用变化及其背景的后续访谈提供重要线索。它们还将被用来触发简短的定性“身份改变”访谈（n=36）。为了组织和通知我们的调查，我们将使用更新的概念模型Zinberg的经典DSS框架。定性分析将使用扎根理论方法进行。低FHI是一个被忽视的药物研究领域，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中海洛因使用变化的知识基础。

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.