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Contextual influences on femoral injecting behaviour in the UK randomised injectable opiate treatment trial
Peter Miller, Senior Clinical Research Worker, National Addiction Centre, London
Abstract
Femoral injecting amongst participants of the Randomised Injectable Opiate Treatment Trial (RIOTT) has created a number of procedural, ethical and medical dilemmas for staff, clients and researchers. This study investigated the effect on femoral injecting behaviour of a drug consumption room (DCR) in the context of the RIOTT currently being conducted at the Maudsley Hospital, South London. It uses in-depth qualitative interviews with 10 RIOTT clients to investigate the effects of this environmental intervention on the injecting behaviour of individuals who injected femorally upon treatment entry. Interviewees were selected on the basis of membership in one of four groups: 1) never injected femorally, 2) injected femorally prior to trial and have ceased completely, 3) injected femorally prior to trial and have ceased within the DCR, and 4) have continued to inject femorally the inside and outside clinical settings. The paper uses case studies and clinical protocols to interpret changes in behaviour in injecting behaviour in regards to the goals of treatment. Preliminary results indicate that there are major advantages and disadvantages associated with femoral injecting. The most commonly reported reason for commencing femoral injecting was a lack of other viable veins and interviewee narratives illustrate how this issue use addressed within the context of the DCR. Within this setting, the paper explores the boundaries of harm reduction in the context of a traditional 'risk boundary' within the 'ideal' risk environment. Other issues explored include: gender differences in femoral injecting episodes, femoral injecting as a risk boundary and the importance of time pressures as a major predictor of choosing to inject femorally.
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Biography
Peter is a Senior Clinical Research Worker at the National Addictions Centre, Institute of Psychiatry, King's College London and the Maudsley Hospital. He also acts as Addictions advisor to The Pilgrim Trust and the J. Paul Getty Jnr Charitable Trust. Prior to this he held the position of Research Fellow at Turning Point Alcohol and Drug Centre (Australia), a position he held for seven years. In 2002, he completed his PhD entitled Dancing with Death: Risk, Health Promotion and Injecting Drug Users. The thesis was an in-depth investigation into the risk behaviours of injecting drug users. It consisted of qualitative and quantitative in depth interviews with 60 heroin users over a two month period. Peter is also currently conducting A Community Impact of a Prescription Heroin Trial in the UK and a study into the Prevalence of Funding Body Regulation of Research Products. His previous research experience includes: Heroin Use in Geelong: An Investigation into the Impact of Heroin Use on a Major Regional Centre, Benzodiazepine and pharmaceutical opiate misuse and their relationship to crime, an author of A study of the impact of the heroin 'drought' in Melbourne: Results of the Drug Availability Monitoring Project (DAMP), the Victorian Psychostimulant Monitoring Project: Trialling Enhanced Drug Trend Monitoring of Melbourne Psychostimulant Markets and four years as a co-investigator of the Illicit Drug Reporting System (IDRS). Before leaving Australia his major project was to design and implement the qualitative arm of The causes, course and consequences of the heroin shortage in Australia. Peter has also been a lecturer in Sociology of the Law, Social Research Methods and Sociology of Health and Illness at Deakin University, Geelong between 1999 and 2003. Peter has a substantial involvement in local community drug issues in his home town of Geelong, Australia having been a member of the local Barwon Drug Advisory Committee for the past 5 years and acting as a consultant.
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