Grant: Travel Awards - Institute Community Support

Despite the proliferation of fentanyl in North America, the impact of this drug market change on injection initiation processes has not been examined. An understanding of the dynamic between drug supply and injection initiation norms will help inform interventions to prevent injection initiation, which are imperative for preventing HIV. We explore how people who inject drugs (PWID) in Vancouver, BC, understand and navigate social norms of initiating others into injecting within the context of an opioid overdose crisis. In-depth interviews were conducted with 19 PWID who reported helping someone inject for the first time. Participants expressed moral dilemmas about assisting others with injecting. While participants described a 'moral code' prohibiting assisting injection-naïve individuals, this code was not the sole consideration shaping social action around injection initiation. Rather, PWID made decisions about whether and how to assist novice injectors with consideration for social norms around 'inter-personal responsibility'. Some PWID were reluctant to assist novice injectors due to uncertainties around drug potency and concerns about being criminally liable for the overdose deaths of those who they assisted. However, PWID also sought to protect novice injectors from harms associated with an increasingly potent drug supply by providing them with injection assistance, education, and supervision. Assisting novice injectors was seen as a form of harm reduction to prevent novice injectors from using alone or engaging in riskier injection practices. Our findings suggest that efforts to prevent injection drug use must be balanced with ensuring novice injectors have access to safer injecting environments. Structural interventions reducing the vulnerability of novice injectors should be prioritized, including the implementation of supervised injection sites allowing for assisted injection, Good Samaritan laws, and policy changes conducive to safer drug supply.