The social context of risk taking and harms of injecting novel psychoactive substances (NPS) in Scotland: a qualitative study

Aims: This qualitative study examined the social contexts, risk behaviours and harms of people who inject novel psychoactive substances (NPS) in Scotland.

Background: NPS have been increasingly prevalent in drug markets for over a decade although identification of new NPS to the European Monitoring Centre for Drugs and Drug Addiction peaked pinnacle in 2014 and 2015 (EMCDDA, 2018). While much research has been conducted about the use and potential harms caused via non injection use of NPS, less is known about the social context surrounding the use of and harms associated with injection of NPS. Given an identified increase in NPS injecting amongst people who inject drugs (PWID) in Scotland (<1% in 2008/09 to 11% in 2015/16 (McAuley et al, 2019), this study was funded to examine the social context surrounding decisions to inject NPS, risk taking and associated harms.

Methods: This qualitative study used face to face interviews and recruited participants using purposive (up to 45 participants) and snowball sampling (up to 15 participants) to target those in contact with and those not in contact with services. Recruitment was done in injecting equipment provision services in three Health Board areas of Scotland in 2018. Inclusion criteria were being 18 years or over and having injected any NPS at least once in the 6 months. The interviews were conducted in private and later transcriber verbatim. Analysis was done using NVivo 12 and framework analysis (Gale et al, 2013) was utilised. Participants received a £25 in shopping vouchers to compensate them for their time. Relevant ethical approvals were granted to conduct the study.

Findings: 46 participants took part (10 females). The mean age of participants was 36 years (range 21-53). Most participants reported injecting synthetic stimulants. The overall social contexts of injecting NPS was very different to injecting opiates and appeared to contribute to greater risk taking with regard to sharing of drugs and injecting equipment, more public injecting and being injected by others. Other harms experienced were acute and severe and occurred rapidly.

Conclusion: NPS injecting continues amongst PWID in Scotland, mainly in the form of synthetic stimulants. This study has found that injecting synthetic stimulants is associated with greater risk taking and extreme harms amongst those who have injected and/or continue to inject NPS. Services need to be aware of these issues and consider providing additional support including having discussions with PWID about safer injection of NPS and minimising the risks associated with sharing drugs and drug injecting equipment.