Multiple Sources of Stigmatization in the Lives of Immigrant Young Adults from the Former Soviet Union with Opioid Use Problems

Background and Purpose

Despite scant attention in social work and public health research, emerging evidence suggests that immigrant young adults from the former Soviet Union (FSU) are engaging in opioid use and injection drug use (IDU) in numbers which parallel alarming trends nationwide. These trends includes progression to heroin use and IDU and injection-related risk behavior within peer networks, as well high incidence of hepatitis C virus (HCV) among young injectors under age 30. However, evidence suggests that patterns of opioid use and utilization of drug treatment and harm reduction services among FSU youth may be influenced by acculturation and ecological challenges embedded in experiences of drug-related stigmatization within their immigrant communities. Considering their distinctive acculturation stressors, this presentation will explore processes of stigmatization that shape the lives of FSU youth who engage in opioid and injection use as they occur in multiple spheres, including their local Russian community, peer and familial networks.

Methods

This grounded theory qualitative analysis draws upon data from a larger mixed-methods study examining FSU youths’ drug-use trajectories. In-depth, semi-structured interviews were conducted with a purposive sub-sample of 26 young adults, 17 of whom reported recent nonmedical use of prescription opioids and/or heroin use and 9 of whom were currently engaged in treatment for problematic opioid use. Semi-structured interviews explored domains that include youths’ drug use histories, immigration and acculturation experiences, as well as relationships with familial and peers networks.  In efforts to further contextualize youths’ narratives, semi-structured interviews were also conducted with 12 FSU immigrant parents of opioid-using youth, and 9 interviews, and 2 focus groups or individual interviews were conducted with 20 staff members of drug treatment or harm reduction programs. All interviews and focus groups were audio-recorded, transcribed and analyzed using the software program Atlas.ti. The grounded theory approach to analysis was conducted by three team members who used open, focused and theoretical coding processes to identify salient themes.

Results

Findings revealed that FSU immigrant youth reported perceptions of drug-related stigmas on multiple levels, within their Russian-speaking community and within their more micro familial systems and peer networks. These stigmas were attached to how opioid and injection drug use violated community norms of acceptable acculturation behaviors and signified failure. Moreover, data from FSU parents and service providers support this finding indicating that these systems enact stigma towards drug-using youth thereby fostering internalized shame. Moreover, interviews revealed that stigmas were often embedded in harsh and discriminatory Soviet-era policies towards drug users that promoted a lack of awareness of psychoactive drugs and addiction. Consequently, these stigmas created barriers to youth’s decisions to seek treatment and engage in harm reduction services.

Conclusion and Implications

Findings from this multiple participant group study expands upon existing research efforts by emphasizing the unique challenges of drug-related stigmatization embedded in youth’s acculturation and immigration processes. We discuss implications for interventions such as culturally-tailored community-wide educational awareness efforts and peer-based modalities to combat stigma and promote greater utilization of harm reduction practices.