@article{bc85030a719b452f83d3373e3c7bb665,
title = "Safety in solitude? Competing risks and drivers of solitary drug use among women who inject drugs and implications for overdose detection",
abstract = "Background and aims: Solitary drug use (SDU) can amplify risks of fatal overdose. We examined competing risks and drivers of SDU, as well as harm reduction strategies implemented during SDU episodes, among women who inject drugs (WWID). Design: A cross-sectional qualitative study, including telephone and face-to-face in-depth interviews. Setting: Baltimore City, MD, USA. Participants: Twenty-seven WWID (mean age = 39 years, 67% white, 74% injected drugs daily) recruited via outreach and street intercept (April–September 2021). Measurements: Interviews explored the physical (i.e. indoor/private, outdoor/public) and social (i.e. alone, accompanied) risk environments in which drug use occurred. Guided by the principles of emergent design, we used thematic analysis to interrogate textual data, illuminating women's preferences/motivations for SDU and strategies for minimizing overdose risks when using alone. Findings: Many participants reported experiences with SDU, despite expressed preferences for accompanied drug use. SDU motivations clustered around three primary drivers: (1) avoiding opioid withdrawal, (2) preferences for privacy when using drugs and (3) safety concerns, including threats of violence. Participants nevertheless acknowledged the dangers of SDU and, at times, took steps to mitigate overdose risk, including naloxone possession, communicating to peers when using alone ({\textquoteleft}spotting{\textquoteright}) and using drugs in public spaces. Conclusions: WWID appear to engage frequently in SDU due to constraints of the physical and social environments in which they use drugs. They express a preference for accompanied drug use in most cases and report implementing strategies to mitigate their overdose risk, especially when using drugs alone.",
keywords = "Drug overdose, injection drug use, opioids, qualitative research, solitary drug use, substance use, using drugs alone",
author = "Rosen, {Joseph G.} and Glick, {Jennifer L.} and Leanne Zhang and Lyra Cooper and Olatunde, {Praise F.} and Danielle Pelaez and Saba Rouhani and Sue, {Kimberly L.} and Park, {Ju Nyeong}",
note = "Funding Information: This work was supported by the Johns Hopkins University Center for AIDS Research, an NIH‐funded program (P30AI094189). J.G.R. was supported by a predoctoral training grant from the National Institute of Mental Health (F31MH126796). J.N.P. was supported by a grant from the National Institute of General Medical Sciences (P20GM125507). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the NIH. We thank all the women who graciously and candidly shared their time and experiences while participating in this study. We acknowledge Drs Laura Beres, Sheree Schwartz and Susan Sherman for their input into the study's design, including development of data collection instruments. Lastly, we thank Teagan Toomre for providing administrative and logistical support for data collection activities. Funding Information: This work was supported by the Johns Hopkins University Center for AIDS Research, an NIH-funded program (P30AI094189). J.G.R. was supported by a predoctoral training grant from the National Institute of Mental Health (F31MH126796). J.N.P. was supported by a grant from the National Institute of General Medical Sciences (P20GM125507). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the NIH. We thank all the women who graciously and candidly shared their time and experiences while participating in this study. We acknowledge Drs Laura Beres, Sheree Schwartz and Susan Sherman for their input into the study's design, including development of data collection instruments. Lastly, we thank Teagan Toomre for providing administrative and logistical support for data collection activities. Publisher Copyright: {\textcopyright} 2022 Society for the Study of Addiction.",
year = "2023",
month = may,
doi = "10.1111/add.16103",
language = "English (US)",
volume = "118",
pages = "847--854",
journal = "Addiction",
issn = "0965-2140",
publisher = "Wiley-Blackwell",
number = "5",
}