PhD defence: Kristin Hanoa

Kristin Hanoa is defending her thesis for the degree philosophiae doctor (PhD) at the University of South-Eastern Norway.

• Read the thesis here

She has completed the PhD programme in Person-centred health care. The doctoral work has been carried out at the Faculty of Health and Social Sciences.

Both the trial lecture and the PhD defence are open to the public.

Summary

In the dissertation I explore perspectives on risk, pleasure and overdose among people who inject drugs (PWID). The aim is increased knowledge about injecting drug use and the social meanings of risk and overdose in the context of PWID’s everyday lives. The key arguments are that contexts and the individual’s overall life situation need to be addressed in the overdose prevention work. PWID live their everyday lives in social environments that influence their perceptions of risk and survival. This illustrates the importance of understanding drug injecting not only as an individual project, but also as social processes and adaptive strategies related to sociostructural factors such as social interaction and learning, living conditions, and everyday life in a marginalized environment.

Norway is one of the countries in Europe with a high and stable overdose-related mortality rate. Yet, little is known about the views and opinions of PWID themselves. This thesis is based on qualitative interviews with 80 PWID recruited from low-threshold services in five Norwegian cities. The thesis shows how PWID’s perceptions of their drug use practices, entail multiple social meanings and experiences developed in social interaction and in the context of their everyday lives in the risk environment. Participants described a complex range of attractions towards injecting drug use and how their experiences evolved from a fear of the needle, to embracing it as a meaningful practice. This highlights how perceptions of injecting and risk are relational and socially contingent.

The thesis also illustrates that PWID participate in risk environments which involve high levels of distress, fear and stigma. Despite the elevated risk of overdose death, these contextual factors made them prefer solitary injecting, involving a perceived notion of safety from an unpredictable environment, avoiding shame by not being seen while injecting as well as contextual pleasures that were maximised by injecting alone. This highlights the competing priorities among PWID, and that solitary injections should be understood as an adaptive strategy.

Importantly, the thesis highlights the complexity of overdoses, and challenges assumptions about the relationship between knowledge of risk and risk avoidance. PWID did not always personalize the risk, or they considered it as a part of their high-risk lifestyle. They also expressed an indifference towards survival in which avoiding death, the main rationale of overdose interventions, was viewed with indifference. This is important for understanding the complexity of overdose mortality and should be reflected in future harm-reduction initiatives, and where the fluctuating spectrum of ambivalence underlying overdoses may contribute to a better approach to how safe using messages use are conveyed and how well they resonate with PWID.