It's like Playing Russian Roulette: Perceptions of Negative Consequences of Drug Use Among a Sample of Women Who Use Drugs Seeking Harm Reduction Services

Background: Recent prevalence estimates suggest women make up one-third of all persons who use drugs globally and one-fifth of those who inject drugs. While men are more likely to use illicit substances compared to women, women are more likely to report more severe relapse and craving experiences. Women’s options for care are often grounded in white, Eurocentric, male models of treatment; this lack of gender-sensitive programming can prevent help-seeking behavior among a subpopulation that is more likely to experience negative consequences associated with their drug use. Moreover, there is a dearth of knowledge regarding how women access harm-reduction services. This study addresses the limited research base surrounding women who use drugs to center their lived experiences to understand their perceived negative consequences of illicit drug use.

Methods: Semi-structured interviews were conducted with twenty women who use drugs seeking care at a local harm reduction agency in Chicago. Recruitment was performed by providers working at the harm reduction agency among eligible patients, including if they 1) identified as a woman, 2) were 18 years or older, and 3) reported illicit drug use within the past 30 days of the interview. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview questions to understand participant experiences using substances and harm reduction services in addition to recommendations for future implementation and integration of harm reduction services into the healthcare continuum. CFIR guided a deductive approach among a team of four coders that achieved coding consensus over the course of several meetings. A thematic analysis was conducted with the qualitative data (n=20) utilizing Dedoose software.

Results: The average participant identified as a 47-year-old, Black (n=13, 65%), cisgender (n=16, 80%) woman with a history of completing at least some college (n= 12,60%); most women reported generating most of their income via criminalized acts (n=13, 65%). Three main themes were identified from participant interviews that emphasize the perceived negative consequences of illicit drug use, including 1. stigma (ex: healthcare professionals’ assumptions of what treatment they deserve; law enforcement confiscation of clean needles; judgment from family); 2. competing physiological needs (ex: the preference of getting arrested over experiencing withdrawal; deciding whether to eat or find the next fix; getting too much sleep and being sick in the morning); and 3. relational dynamics (ex: drug use intimately connected to romantic relationships; making loved ones worry about their wellbeing; death of loved ones and relapse).

Conclusions: These preliminary results highlight the perceived negative consequences associated with illicit drug use among a sample of women seeking care at a harm reduction clinic. Results suggest the negative consequences may not align with assumptions of formal treatment frameworks regarding motivators and readiness for change; additionally, qualitative feedback underscores the importance of integrating harm reduction service options into formal treatment programming and other healthcare settings, like primary care and women’s health clinics. This line of research is critical to understanding facilitators of help-seeking behavior, particularly among an understudied, historically marginalized subpopulation.