Transition to and Away from Injecting Drug Use among Young Drug Users in Tehran, Iran: A Qualitative Study

Background: Iran has a large population of non-injection opioid users potentially at risk of initiation of drug injection. Objective:Weimplementedaqualitative study to characterize the factors facilitating transitionfromnon-injectiondruguse (NIDU) to injection drug use (IDU) and vice versa. Materials and Methods:We conducted 42 in-depth interviews among purposefully selected groups of injecting and non-injecting drug users and health workers, in 2011 in Tehran, Iran. The interviews were audio-recorded, transcribed and coded using OpenCode 3.6 software. Results: The predominant factor for transition from NIDU to IDU was a high level of drug dependence. IDU decreased the cost associated with drug use by several fold in the short-term. The influence of other injectors, either by learning directly from, encouraged by, feeling coerced by, or identifying with a lifestyle was also mentioned as a causal factor in the transition to IDU. Pleasure-seeking or desire to experience an immediate rush were rarely reported; rather, themes of the need to maintain functionality, reduce pain, and overcome financial difficulties emerged. Vein damage and other IDU-related physical health problems, as well as pressure from family were reasons for reverse transition (IDU to NIDU). Conclusions: New harm reduction approaches could focus on blocking the transition from NIDU to injection and promoting the return to less harmful routes of administration.