Police crackdowns, structural violence and impact on the well-being of street cannabis users in a Nigerian city

The social-structural contexts of cannabis consumption and harm reduction among young Nigerian women

BACKGROUND

Young women remain under-represented in the research literature on young people's cannabis use. This study explored cannabis use and harm reduction practices of young Nigerian women.

METHODS

The study draws on 19 in-depth interviews conducted with young women aged 21-35 years who were recruited through time-location sampling in Uyo, Nigeria. Interview transcripts were subjected to thematic coding and analysis.

RESULTS

Accounts highlighted a rapid progression from occasional consumption during hang-outs to regular and heavy consumption for most participants. Frequent and heavy cannabis use, shaped by trauma, stress and mental health problems linked to participants' marginal social locations, established a context of risk for health harms. The participants sought to reduce harms by attempting to reduce frequency and quantity of cannabis consumed, often with limited success. They also micro-dosed to monitor drug effects, avoided mixing cannabis with more potent drugs, sought out cannabis strains with lower THC as well as consuming privately to reduce social harms such as violence and police arrest associated with using in street milieus. On the other hand, cannabis consumption was seen as helping to reduce harms by providing a relatively safer and less addictive alternative to drugs such as heroin and pharmaceutical opioids, preventing high-risk sexual exchanges often associated with opioid withdrawal among women, and relieving pain.

CONCLUSIONS

Cannabis was consumed recreationally at first, and harmful consumption patterns developed from using cannabis to treat the psychological symptoms of structural inequalities. The analysis supports the social-structural production of drug-related harms, foregrounding the importance of structural-level interventions for creating an enabling environment for safer consumption.

Medicinal use of cannabis: A qualitative study of the perspectives of doctors and pharmacists from six African countries

We conducted a qualitative study to examine the enablers and barriers influencing the implementation of medical cannabis from the perspectives of practicing doctors and pharmacists within the African context. Interviews were conducted to investigate medical professionals' perceptions and concerns regarding medicinal cannabis. Three major themes were identified: beliefs about consequences, optimism, and environmental resources and context. Depending on the context of use, medical professionals described cannabis as potentially useful as an adjunct medicine and yet problematic owing to knowledge and social barriers, particularly religion. Implementation strategies tailored to address structural and social concerns to providing optimal care are needed to ensure that medical professionals are well versed in policy and clinical aspects.

COVID-19 pandemic policing and public (non)compliant behaviour: dataset from Nigeria

OBJECTIVES

The unprecedented nature of COVID-19 pandemic lockdown order projected to contain the pandemic and the global use of the police to enforce the order has necessitated the investigation of public (non-compliant) behavior and police intervention (misconduct). Given that the phases of easing the lockdown and reopening of the economy were already underway in Nigeria in September 2020, four months post-lockdown, this period was deemed suitable to collect the data.

DATA DESCRIPTION

The data consists of 30 participants' (25 individuals and five police personnel) views regarding the reasons that exacerbated the violation and the 'alleged' unethical practices of police personnel while enforcing the lockdown. However, it benefits the broader scientific community in areas such as policing, disaster risk reduction, pandemic management and public administration. It is valuable in police reforms against unethical practices and gives clear policy directions to policymakers and authorities in managing future public health emergencies. Also, it is useful in understanding the public awareness about the pandemic and public (mis)trust and disposition towards the government authorities on the obedience to law and public health safety advisories to contain a pandemic.

Retail Drug Trade, Effects on Neighbourhoods, and Sellers’ Navigational Strategies: Accounts of Nigerian Dealers

Studies have examined the negative effects of drug markets on neighbourhoods. But few explore the views of drug sellers. Drawing on 31 in-depth interviews with Nigerian retail drug sellers, we explore why they sell drugs, the effects of drug markets on neighbourhoods, and how they navigate social and legal problems. The participants sold drugs as a means of livelihood in the context of poverty and economic decline. Drug market activities were seen as nuisance, and as fostering crime and violence in neighbourhoods. These views stirred opposition from residents and led to police raids on drug scenes. Drug sellers navigated policing and opposition by concealing drug trade, selling covertly and reducing nuisance among other strategies. We argue that retail drug trade is shaped by the imperatives of survival in the context of poverty. Providing alternative means of livelihood for drug sellers offers potential to curb drug selling and related problems.

The socio-economic context of entry and exit from retail drug dealing: Exploring the narratives of Nigerian dealers

BACKGROUND

There is a significant body of research that shows how economic decline, poor livelihood conditions and limited employment opportunities influence entry into retail drug distribution. Available research, however, neglects the lived experiences and accounts of these dynamics and how they inform exit from the trade, especially in African countries. This study explores the socio-economic context of entry and exit from retail drug distribution in Nigeria.

METHODS

Data were gathered through in-depth interviews with 31 male retail drug dealers (aged 26-45 years) in Uyo, Nigeria. They were recruited via snowball sampling from diverse drug networks in the city. Recorded interviews were transcribed verbatim, and a framework approach was applied to code and analyse the data.

RESULTS

Most participants took up retail drug trade as a means of income generation under difficult socio-economic conditions. Others entered the trade as part of a youthful search for social autonomy or to pursue entrepreneurial opportunities, although economic conditions formed the wider backdrop of their choices. Participants' social networks, including friends and relations, facilitated their entry into drug trade through linkages to suppliers. For many, the drug trade was seen as offering limited scope for social and economic mobility. This made them to aspire to quit the trade, with some seeing it as a pathway to legitimate livelihoods. Exit prospects were constrained by limited social support and entrenchment in the drug economy.

CONCLUSIONS

Since socio-economic conditions are central to both entry and exit from drug trade, these should form the focus of policies addressing retail drug distribution. A development-based approach to policy that seeks to guarantee social and economic rights through the realization of key sustainable development goals offer potential to curb retail drug distribution in Nigeria.

Negotiating an Illicit Economy in the Time of COVID-19: Selling and Buying Dilemmas in the Lives of People Who Use Drugs in Scotland

The impact of COVID-19 itself and societal responses to it have affected people who use drugs and the illicit drug economy. This paper is part of a project investigating the health impacts of COVID-19 related control measures on people who use drugs in Scotland. It examines their roles and decisions as economically situated actors. It does this within a moral economy perspective that places economic decisions and calculations within a context of the network of social obligations and moral decisions. The paper uses a mixed methods approach, reporting on a drug trend survey and in-depth interviews with people who use drugs. It finds they were affected by restrictions in the drug consumption context and changes in the supply context, both in terms of what was supplied and changes in the relationship between sellers and buyers. Face to face selling became more fraught. Participants in more economically precarious circumstances were faced with dilemmas about whether to move into drug selling. The double impact of loss of income and reduced access to support networks were particularly difficult for them. Despite the perception that the pandemic had increased the power of sellers in relation to their customers, many full-time sellers were reported to be keeping their prices stable in order to maintain their relationships with customers, instead extending credit or adulterating their products. The effect of spatial controls on movement during the pandemic also meant that the digital divide became more apparent. People with good access to digital markets and easy drug delivery through apps were in a better position to manage disruption to drug sales contexts. We make recommendations in relation to how policy can respond to the interests of people who use drugs in a pandemic.

Enforcement of COVID-19 pandemic lockdown orders in Nigeria: Evidence of public (non)compliance and police illegalities

Given the public resentment that trailed the unprecedented lockdown order enforced as a public health emergency control strategy to contain the spread of Coronavirus Disease (COVID-19) pandemic, this study explored citizens' compliance with the order and how its enforcement occasioned illegal police practices in Nigeria. With a qualitative approach, this study recruited 90 participants using varieties of sampling methods to understand public behaviour and police conduct in the enforcement of the order. From the insights gathered with a semi-structured interview and analysed with the thematic analysis method, the study observed that economic hardship, unavoidable matters from the citizens' end and mistrust of authorities fueled non-compliance. Such mistrust amplified misinformation during the pandemic. Although there was a reasonable level of compliance, the pre-existing police illegalities (extortion and bribery) facilitated the cases of non-compliance in Nigeria. Also, hostility ensued between police personnel and citizens during the enforcement of the lockdown. Therefore, this study advised the government and stakeholders on the imperatives of adequate socio-economic preparations, emphasising public trust and the provision of relief materials. Additionally, it suggested to the police authorities reform ideas to better equip, monitor, and manage police resources for effective handling of future pandemics.

Consumption, not decriminalization: How Nigerian drug dealers/users account for cannabis harms

BACKGROUND AND AIMS

Studies have shown that support for cannabis decriminalization and legalization is highest among users, but there is little research on constructions of cannabis decriminalization in the narratives of users who are also dealers. The aim of this study was to explore discursive constructions of cannabis consumption and decriminalization in dealers'/users' accounts of the drug's harms.

METHODS

A qualitative study was undertaken in which in-depth interviews were conducted with 31 commercially oriented Nigerian men drug dealers who also use drugs. They were recruited through snowball sampling. Data analysis was based on a social constructionist approach to grounded theory, which emphasizes the role of language and discourse in the construction of reality.

RESULTS

While harms from cannabis use were recognized, these were constructed as being relative to consumption practices and user's ability to manage drug effects. Accounts used different discourses and rhetorical strategies to deconstruct popular views of cannabis as a dangerous drug, including minimizing harms by juxtaposing them with harms from more potent drugs as well as with benefits from use. Harms were, however, amplified in relation to decriminalization to delegitimize the policy approach due to concerns about potential increase in consumption and harms to inexperienced consumers.

CONCLUSIONS

Constructions of cannabis-related harms in the participants' accounts served discursively to delegitimize cannabis decriminalization, without stigmatizing its use and the users. There exists a need to raise awareness on cannabis decriminalization and legalization as part of measures to bolster support for policy reforms among stakeholder groups (e.g., consumers).

Status and Impacts of Recreational and Medicinal Cannabis Policies in Africa: A Systematic Review and Thematic Analysis of Published and "Gray" Literature

Background: Despite cannabis's societal ubiquity, several African states remain traditional prohibitionists. However, cannabis is becoming a more explored frontier from a health, human rights, and monetary perspective. A number of African countries have taken to tailoring their policies to better engage in emerging global dialogs. Nevertheless, the focus is majorly on the crop's financial appeal with less consideration on impacts of policies. This review aimed to specifically focus on the identification of existing or pending policies, indicating national positioning in terms of recreational and medicinal cannabis use and summarizing publications addressing related impacts in Africa. Methods: We systematically searched six academic research databases (including Google Scholar), Google, country specific websites, and websites of relevant organizations. Included publications were in English and published between January 1, 2000, and November 31, 2020 (with exception granted to official legislation not in English and/or published earlier than 2000, but still in effect). Reference lists of included publications were screened for potentially relevant publications. Results were synthesized thematically and descriptively. Results: Cannabis is Africa's most consumed illegal substance, its use entrenched in social, political, historical, economic, and medicinal ties. African users constitute a third of the worldly total and cultivation is a major activity. Policies have led to prison overcrowding, accelerated environmental damage, and sourced regional instability. South Africa, Seychelles, and Ghana have decriminalized personal use with Egypt and Mozambique exploring similar legislation. Eleven countries have existing or pending medicinal cannabis-specific provisions. South Africa and Seychelles stand out as having regulations for patients to access medicinal cannabis. Other countries have made provisions geared toward creating export markets and economic diversification. Conclusion: Cannabis policy is a composite and complex issue. Official stances taken are based on long withstanding narratives and characterized by a range of contributing factors. Policy changes based on modern trends should include larger studies of previous policy impacts and future-oriented analysis of country-level goals incorporated with a greater understanding of public opinion.

Rationalities of Space and Drug-Related Harms: Accounts of People Who Inject Drugs in Nigeria

BACKGROUND

Studies have examined how people who inject drugs (PWID) navigate public spaces for drug consumption, but little is known about consumption of drugs in private apartments. This study explores social, structural and physical environment factors influencing injecting practices and the rationalities shaping how PWID make decisions about where to consume drugs.

METHODS

The study is based on qualitative data from 41 in-depth interviews conducted with both homeless and housed PWID recruited through snowball sampling in Uyo, Nigeria. Thematic analysis, framed by the theoretical constructs of structural and everyday violence, and situated rationality theories, was undertaken on transcripts.

RESULTS

Analysis revealed different socio-spatial rationalities underlying decisions about where to use drugs: avoidance of police arrest, convenience and relaxation, avoidance of drug sharing, avoidance of drug-scene violence, and stigma and shame. These factors show the impacts of social, structural and physical environment factors on the lived experiences of PWID. Injecting in private apartments potentially offset the risk of stigma, police arrest and violence linked to public injecting, but increase the risk of overdose and sharing of drugs and needle-syringes based on social relations of trust.

CONCLUSIONS

Findings show that PWID chose between competing risks when deciding on where to inject drugs. Interventions should consider the situated contexts of risk, and adapt harm reduction measures to the risk profile of different populations of PWID.

Structural Violence and Health-Related Outcomes in Europe: A Descriptive Systematic Review

In recent years, there has been a revival of the term “structural violence (SV)” which was coined by Johan Galtung in the 1960s in the context of Peace Studies. “Structural violence” refers to social structures—economic, legal, political, religious, and cultural—that prevent individuals, groups and societies from reaching their full potential. In the European context, very few studies have investigated health and well-being using an SV perspective. Therefore, this paper sought to systematically and descriptively review studies that used an SV framework to examine health-related outcomes across European countries. The review included two studies each from Spain and France, one each from the UK, Ukraine and Russia, and another study including the three countries Sweden, Portugal and Germany. With the exception of one mixed-method study, the studies used a qualitative design. Furthermore, the eight studies in the review used different conceptualizations of SV, which indicates the complexity of using SV as a concept in public health in the European context. Future research that attempts to identify and standardize measures of SV is needed; the knowledge gained is hoped to inform appropriate interventions aiming to reduce the effects of SV on population health.

Intersectional analysis of cannabis use, stigma and health among marginalized Nigerian women

Cannabis use by women has been under-researched, particularly use by marginalized women in developing societies. This article draws on qualitative research in Uyo, Nigeria, to explore how intersecting stigmas around social identity categories (e.g. gender, sex work) shapes cannabis use and contributes to health harms for marginalized women. Qualitative data were collected via in-depth interviews with street-involved female cannabis users, and transcribed, coded and analysed thematically. Initiation of cannabis use was influenced by social networks and sexual relationships. Heavy cannabis use enabled some women to perform alternative femininity thereby challenging the boundaries of appropriate gendered behaviour, while others were pressured by normative expectations to enact moderation according to traditional femininity. Recreational cannabis use overlapped with marginalized forms of use, including using heavily to cope with the mental health sequalae of gender-based discriminations and structural inequities. Cannabis use attracted heightened stigma, operating as part of intersecting stigmatizing identities that adversely impacted mental health and wellbeing. Cannabis stigma does not exist in isolation from other social identity categories that shape women's lives. There exists a need to combat stigma through interventions that seek to mediate changes in gender relations, improve living conditions and access to health-care services for marginalized women.

Redefining recovery: Accounts of treatment experiences of dependent cannabis users in Nigeria

BACKGROUND

Research on addiction recovery describes recovery as a process leading to cessation of drug use. Few researchers have explored alternative views of recovery, and the interplay of individuals' agency and social context in the recovery process. This study explored situated understandings of recovery among cannabis users that emphasized process and contingency.

METHODS

We conducted the study in Uyo, Akwa Ibom State in Nigeria. Participants were current (street-involved) cannabis users aged 21 to 34 (n = 97), recruited through time-location sampling. The study collected data through in-depth, individual interviews, which study staff transcribed, coded, and analyzed thematically.

RESULTS

Participants' accounts indicated a quest for treatment as a means of recovery and redemption (i.e., repairing an identity damaged by dependent cannabis use). Relapse affected recovery when participants defined the latter as abstinence. Framing recovery this way showed the effects of social and structural factors on individual agency and treatment experiences. Yet some participants' accounts highlighted a redefinition of recovery as a process ("recovering"), measured by such outcomes as reduced drug use and improved overall well-being.

CONCLUSIONS

Reframing recovery, as some participants' accounts in our study capture, speaks to the need for treatment programs that are informed by the principles of harm reduction and health promotion. Instead of foisting a singular treatment goal defined as total abstinence onto drug users seeking treatment, treatment should be attuned to the experiences and life circumstances of users and support them in achieving their recovery goals.

Ranking policing strategies as a function of criminal complaints: application of the PROMETHEE II method in the Brazilian context

Purpose

The purpose of this study is modelling of a problem of policing strategy order using a multicriteria method.

Design/methodology/approach

For the construction of the impact matrix strategies under the reduction of crime rates, considering a portfolio of crimes, a questionnaire applied to specialists was used. In a second moment, defined the criteria and strategies to be ordered, the multicriteria PROMETHEE II method was used, which with the help of the Visual PROMETHEE software, emulated the systematised data in the impact matrix and produced the final ordering of the most efficient strategies, in the fight against crime, in the perception of decision makers.

Findings

As a result, this research revealed that radio patrol, when used in a non-randomised manner, is the most effective policing strategy in reducing the 18 criminal demands studied in the perception of decision makers after data emulation with the PROMETHEE II method.

Research limitations/implications

As research implications, it can be inferred that the use of multicriteria methods in the modelling of problems in public security area can contribute to the rationalisation of use of the available means in the fight against crime in large cities. This research showed that it is possible to use customised policing strategies to absolute reality.

Practical implications

The practical impact of this research lies in optimising the resources available to law enforcement agencies in the fight against crime in general.

Social implications

It can be inferred that by choosing appropriate strategies to combat local crime, there is a direct implication in optimising the resources that the government makes available to police agencies. This optimisation allows pressure reduction under the public budget for more features. The model for choosing more effective strategies contributes to local crimes decrease, increasing the sense of the population security.

Originality/value

The originality lies in filling a gap in the literature with the elaboration of the impact matrix of policing strategies in reducing criminal indices and in their associated use in ordering strategies through a multicriteria method. This study contributed to applied police intelligence.

From “Codeine Diet” to “Gutter Water”: polydrug use among Nigerian young adults

Purpose

The purpose of this paper is to explore polydrug use and the factors that motivate the use of multiple substances among selected young adults.

Design/methodology/approach

A total of 23 male and female participants (aged 23-29 years) who use illicit drugs and prescription pharmaceuticals for non-medical purposes were recruited through snowball sampling. Qualitative interviews were conducted, and the data were analysed thematically.

Findings

The use of drug “concoctions” and cocktails was widespread among the participants. Some used what they called Codeine Diet (codeine-based cough syrup mixed with a Coca-Cola® product or malt drink), while others took Gutter Water (a cocktail of cannabis, codeine, tramadol, vodka and juice or water). The use of Monkey Tail (a mixture of local gin, cannabis leaves, stems, roots and seeds) and petrol mixed with glue and La Casera® (carbonated soft drink) combined with Tom-Tom® (menthol-flavoured candy) was also revealed. Pleasure, better highs, the need to experience prolonged intoxication and the use of one drug to douse the effects of another substance motivated polysubstance use.

Social implications

The findings revealed that the reasons why codeine-based cough syrups are mixed with soft drinks (Codeine Diet) include avoiding social discrimination and evading law enforcement agencies. Results suggest that these drug use practices require specifically tailored public health interventions. Social stigmatization against substance users and the use of extra-legal measures by the police should be discouraged to facilitate harm reduction.

Originality/value

This study represents the first qualitative research to explore polydrug use among an understudied Nigerian population.

"Pick up anything that moves": a qualitative analysis of a police crackdown against people who use drugs in Tijuana, Mexico

BACKGROUND

Homeless people who use drugs (PWUD) are often displaced, detained, and/or forced into drug treatment during police crackdowns. Such operations follow a zero-tolerance approach to law enforcement and have a deleterious impact on the health of PWUD. In Mexico, municipal police officers (MPOs) conducted the largest crackdown documented at the Tijuana River Canal (Tijuana Mejora) to dismantle an open drug market. We analyzed active-duty MPOs' attitudes on the rationale, implementation, and outcomes of the crackdown. We also included the involvement of non-governmental allies in the disguised imprisonment as drug treatment referral and potential legal consequences of having illegally detained PWUD.

METHODS

Between February-June 2016, 20 semi-structured interviews were conducted with MPOs in Tijuana. Interviews were transcribed, translated and coded using a consensus-based approach. Emergent themes, trends and frameworks were analyzed through a hermeneutic grounded theory protocol.

RESULTS

Participants recognized the limitations of Tijuana Mejora in effectively controlling crime and addressing drug treatment solutions. MPOs perceived that the intent of the operation was to displace and detain homeless PWUD, not to assist or rehabilitate them. The police operation was largely justified as a public safety measure to reduce the risk of injury due to flooding, decrease drug consumption among PWUD and protect local tourism from PWUD. Some participants perceived the crackdown as a successful public health and safety measure while others highlighted occupational risks to MPOs and potential human rights violations of PWUD.

CONCLUSIONS

Tijuana Mejora illustrated why public and private actors align in enforcing zero-tolerance drug policy. Perceptions of care are often based on captivity of the diseased, not in health and well-being of PWUD. Officer perceptions shed light on the many limitations of this punitive policing tool in this context. A shift towards evidence-based municipal strategies to address drug use, wherein police are perceived as partners in harm reduction rather than antagonists, is warranted.

Operational research applied in the field of public security

Purpose

Because that the crime in a wide way impacts the life of the people in the big metropolis, researchers have treated the question from several angles. The purpose of the paper, under the umbrella of operational research, is to develop a model of the ordering of police strategies, in the fight against crime in general, according to a certain criminal demand.

Design/methodology/approach

For the construction of the impact matrix of the strategies under the reduction of crime rates, considering a portfolio of crimes, a questionnaire applied to specialists was used. In a second moment, defined the criteria and strategies to be ordered, the multicriteria ELECTRE IV method was used, which with the help of the J-Electre software emulated the systematized data in the impact matrix and produced the final ordering of the most efficient strategies, in the fight against crime, in the perception of decision-makers.

Findings

As a result, the research revealed that policing strategies directed at solving specific crimes are the most effective in the perception of decision-makers after the emulation of data with the ELECTRE IV method.

Research limitations/implications

As research implications, it can be inferred that the use of multicriteria methods in the modeling of problems in the area of public security can contribute to rationalization of the use of the means available in the fight against crime in large cities. The research showed that it is possible to use customized policing strategies to a certain reality.

Practical implications

The method presented in this research is directly related to the major strategies: problem-oriented policing and hot spot policing. This method allows public safety managers to consider the possibility of combining different law enforcement strategies in each context. In this sense, the use of the multiple-criteria decision analysis (MCDA) (ELECTRE IV) method allows the evaluation of a large set of alternatives according to a set of established criteria, speeding up the process and reducing subjectivity, allowing the manager to analyze several scenarios with greater clarity and impartiality and choosing an alternative that best solves the proposed problem. The expected result is the rationalization of the available means applied in the search for the reduction of crime rates.

Social implications

The customization of policing strategies, according to criminal demands, implies the efficient way to reduce criminal charges. Reducing criminal rates enables the development of the local economy, tourism and the quality of life of people by exercising their freedom to the full.

Originality/value

The originality lies in filling a gap in the literature with the elaboration of the impact matrix of policing strategies in reducing criminal indices, and in their associated use in ordering strategies through a multicriteria method.

Cannabis Normalization Among Young Adults in a Nigerian City

Drug normalization has been researched extensively in the West. Yet, we know little about how drug use is normalized in non-Western contexts. Drawing on interviews with young adults, this study is the first to explore illicit drug normalization in Nigeria. Cannabis was widely available and easy to access and students were part of the supply chain. Citing therapeutic and functional benefits, participants normalized cannabis consumption, using it to prepare soup, noodles, and birthday cakes. Unlike women, who may give up cannabis use due to stigmatization and marriage, men had no plans to stop its use. Gender determined drug-taking practices and social accommodation of drug users, suggesting differentiated normalization. Men who used cannabis were accommodated by their peers, unlike women, who were stigmatized by female non-users. In general, the findings highlight a shift in illicit drug use practices and noticeable gendered and differentiated social accommodation among peers, although cultural acceptance of illegal recreational drugs remains at the margin.

Beyond prohibition: responses to illicit drugs in West Africa in an evolving policy context

Purpose

The purpose of this paper is to discuss priorities for effective responses to illicit drugs in West Africa in a changing international policy environment.

Design/methodology/approach

The paper analyzes published research, technical papers and reports on drug use and policy responses in West Africa and opines on priorities for drug policy in the region within the post-United Nations General Assembly Special Session (UNGASS) 2016 policy environment.

Findings

Drug use and related harms continue to increase in West African countries despite efforts to reduce drug trafficking and use through legal prohibition. The UNGASS 2016 outcome document enables flexibility in policy interpretation and implementation, which provides an opportunity for governments to prioritize national needs in drug policy. West African countries should prioritize and support research and data collection, prevention, treatment and harm reduction and sustainable livelihoods.

Originality/value

The paper emphasizes the need for West African countries to seize the opportunity created by the ineffectiveness and weakening of the prohibition regime as well as new treaty flexibility following UNGASS 2016 to reform drug policies to prioritize regional and national needs.

The Risk Environment for Adopting and Continuing Injecting Drug Use: A Qualitative Study in Uyo, Nigeria

Background: The bulk of research on adoption of injecting is from Europe and America, despite the existence of syndemics of drug injecting, HIV, and viral hepatitis globally. Objectives: This study explores adoption and continuation of injecting drug use. Methods: The study draws on in-depth interviews with 41 (n = 41) current male and female people who inject drugs recruited via snow-ball sampling in Uyo, Nigeria. A thematic and descriptive analysis was undertaken informed by the risk environment framework and focused on accounts of the factors influencing the process. Results: Accounts emphasized injecting adoption and continuation as a process influenced by individual, social, and structural factors within the risk environment, including concerns for pleasure/efficiency, prestige, exposure to/support for injecting within peer and sexual relationships, availability and purity of drugs, and dependence and increased cost of drug use. Conclusions/implications: Findings highlight the need to prevent adoption of injecting, reduce prevalence of injecting, and promote safe injecting through multi-level interventions, including peer-driven education, drug treatment services, needle and syringe distribution, oral drug substitution, and law enforcement targeting drug suppliers. The need for equivalent pleasure with minimal risk points to the strategic importance of peer interactions for inculcating new understandings of drug use and pleasure.