Social influences on the transition to injection drug use among young heroin sniffers: A qualitative analysis

Little attention has been placed on preventing transition from non-injection to injection drug use. The primary purpose of this qualitative study was to explore the spheres that influence young drug users' transition from heroin sniffing to injecting among a sample from Baltimore, MD, USA. Nineteen in-depth qualitative interviews were conducted with young (ages 16-29) injection drug users who had begun injecting within the 3 years prior to being interviewed. Participants were primarily male. Average age and duration of injection was 24 and 15 months, respectively. There was a range of factors that influenced participants' drug use trajectories. These influences were: families; friends; sexual partners; the expense of sniffing compared with the perceived cost of injecting; and the endemic nature of injection in their local neighborhoods. Interventions need to adopt harm reduction approaches targeting heroin sniffers in an effort to prevent transition to injection. Although many began injecting due to the assumption that they would spend less money on drugs, the cost of injecting soon equaled or surpassed that of their sniffing habit. Such issues need to be addressed in prevention programs. Intervening upon social networks of young drug users represents one way to target the complex social environments that promote transitions into injecting.