Why young male integrated drug users transition from non-injecting pattern to heroin injection in the contemporary thai drug context

Abstract

Opioid use and misuse are understudied in Thailand despite evidence suggesting that a portion of young people are initiating opioids while another portion of young Thai male integrated drug users (YMID) is transitioning to heroin injection. This study aims to answer why Thai YMID transition to heroin injection by capturing and analyzing the individual and social risk factors influencing these transitions. The interview guideline was inspired by the “Drug, Set and Setting” framework developed by Zinberg and encompassed several theoretical concepts stemming from Sociology, Psychology, Addiction theory and Criminology. Twenty semi-structured in-depth life history interviews were conducted between the months of December 2019 to January 2020 in the Bangkok metropolitan area with young Thai male opioid users who transition to heroin injection. Results revealed that YMIDs who abusively use opioid, transition to heroin use within 20.8 months and progress to heroin injection within 6.2 months. Respondent's decisions at the early stages of their drug career were mainly influenced by their social environment, which modified their initial representations regarding drug use, provide the opportunities and access to the substances, and taught newcomers how to use and enjoy each substance. During the latter stages of their career, respondents were more likely to use heroin to alleviate their withdrawal symptoms and were instrumenting their group to reduce the risk of overdose death and reduce heroin purchase cost. In conclusion, the interaction of specific social and individual factors at different stages modify the meanings, motivations, knowledge and practices of some YMID, who ultimately transition to people who inject heroin. Therefore, drug counseling interventions should be tailored for each individual based on the stage they are currently in. Furthermore, and despite the prevalence of methamphetamine, drug prevention program in Thailand should encompass young opioid users in their intervention. Finally, the extent of opioid / YaPro impact on the transition to heroin needs to be further investigated.