Peer helpers' struggles to care for "others" who inject drugs

Background: Users who access needle exchanges are sometimes recruited to act as secondary distributors in an effort to reach a broader range of individuals who inject drugs. Although evaluations have demonstrated the efficiency of such approaches, more recent research has begun to uncover particular challenges associated with assuming these intermediary roles. Methods: This article provides insights drawn from four focus-group sessions with 17 volunteers, termed natural helpers, who have between 1 and 14 years experience acting as secondary distributors for an Atlantic Canadian needle exchange. Results: From the perspective of the natural helpers involved in this research, medical professionals consider those who inject drugs to be undeserving of the care accorded to more "responsible" patients. As a consequence of such disenfranchisement, natural helpers find themselves drawn into many forms of informal "doctoring" that extend far beyond their official roles as secondary distribution agents. In addition to providing syringes, training new users in safe injection procedures and promoting the use of sterile equipment, natural helpers try to dissuade people from starting to inject, act as first responders for overdoses, test drug potency, administer first aid, share prescription drugs such as antibiotics, offer temporary housing, counsel on emotional/psychological issues, and support those who are striving to reduce their drug consumption. Conclusion: The practices that have arisen in response to the distancing from professional health care experienced by those who inject drugs pose serious dilemmas and risks for not only users and natural helpers but also the general public. (C) 2015 The Author. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).