Making Connections: When is Sharing Not Such a Good Idea?

Figure 1. Crack cocaine users in downtown Vancouver. (Photo courtesy of Wikimedia commons)

Choosing a research methodology depends on a number of factors, including the purpose of the research and the audience for whom the research is intended. If we consider the type of research that might go into producing a government policy document on the effectiveness of safe injection sites for reducing the public health risks of intravenous drug use, we would expect public administrators to want “hard” (i.e., quantitative) evidence of high reliability to help them make a policy decision. The most reliable data would come from an experimental or quasi-experimental research model in which a control group can be compared with an experimental group using quantitative measures.

This approach has been used by researchers studying InSite in Vancouver (Marshall et al. 2011; Wood et al. 2006). InSite is a supervised safe-injection site where heroin addicts and other intravenous drug users can go to inject drugs in a safe, clean environment. Clean needles are provided and health care professionals are on hand to intervene in the case of overdose or other medical emergency. It is a controversial program both because heroin use is against the law (the facility operates through a federal ministerial exemption) and because the heroin users are not obliged to quit using or seek therapy. To assess the effectiveness of the program, researchers compared the risky usage of drugs in populations before and after the opening of the facility and geographically near and distant to the facility. The results from the studies have shown that InSite has reduced both deaths from overdose and risky behaviours, such as the sharing of needles, without increasing the levels of crime associated with drug use and addiction.

On the other hand, if the research question is more exploratory (for example, trying to discern the reasons why individuals in the crack smoking subculture engage in the risky activity of sharing pipes), the more nuanced approach of fieldwork is more appropriate. The research would need to focus on the subcultural context, rituals, and meaning of sharing pipes, and why these phenomena override known health concerns. Graduate student Andrew Ivsins at the University of Victoria studied the practice of sharing pipes among 13 habitual users of crack cocaine in Victoria, B.C. (Ivsins 2010). He met crack smokers in their typical setting downtown and used an unstructured interview method to try to draw out the informal norms that lead to sharing pipes. One factor he discovered was the bond that formed between friends or intimate partners when they shared a pipe. He also discovered that there was an elaborate subcultural etiquette of pipe use that revolved around the benefit of getting the crack resin smokers left behind. Both of these motives tended to outweigh the recognized health risks of sharing pipes (such as hepatitis) in the decision making of the users. This type of research was valuable in illuminating the unknown subcultural norms of crack use that could still come into play in a harm reduction strategy such as distributing safe crack kits to addicts.