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

Iran has a large population of non-injection opioid users potentially at risk of initiation of drug injection.
We implemented a qualitative study to characterize the factors facilitating transition from non-injection drug use (NIDU) to injection drug use (IDU) and vice versa.
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.
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).
New harm reduction approaches could focus on blocking the transition from NIDU to injection and promoting the return to less harmful routes of administration.