A Good Doctor is Hard to Find: Affect and Skill among Persons who Inject Drugs

• In Event: 506 - Regular Session. Substance Use, Abuse, Treatment

Abstract

This paper presents a detailed case on the injection drug use practice of assisted injection, that can be abstracted out to affect, power, and micro-interactions. The case study is based on interviews and ethnographic observations with 45 injection drug users who received or provided injection assistance in San Francisco in 2015. In San Francisco, about 2.3% of the population inject illicit drugs. Over half of these persons give or receive injection assistance. People receiving injection assistance are over twice as likely than other injection drug users to be infected with HepC and HIV, and are at increased risk of venous damage, overdose, theft, and robbery. Much of the public health literature on assisted injection presents the practice as a gendered power dynamic of male domination and female submission. I argue that these findings have been created through the framing of the research question and the sampling methods. Abstraction to models of gender obscures the interaction. This paper offers an alternative, non-gendered explanation for the unequal power dynamics at work in the assisted injection interaction. I propose a model of assisted injection practices as an illustration of micro dynamics of power, influenced by affect, and legitimated through a medicalized discourse. Understanding assisted injection power dynamics as arising in the interaction captures the risks for all recipients, and the power imbalance that results from resource and skill inequalities. This approach can be extended to analyze interactions in other fields between those who have resources and skills, and those who do not.

Author

• Sarah Brothers, Yale University