Withdrawal Symptoms Hindering Harm-Minimization and Drug Detoxification Efforts: Experiences of Injecting Drug Users in Nepal

In this study, the authors explored the perception and strategies used by 20 injecting drug users (IDUs) as they regularly confront life-threatening complications stemming from their drug use. The 20 IDUs were from four urban centers of Nepal: Kathmandu Valley, Pokhara, Narayanghaat, and Hetauda. The phenomenological study was conducted, using individual in-depth interviews ranging from 1 to 2 hours in length. All data were analyzed using the analytical approaches of grounded theory. It was found that the urgency and severity of withdrawal symptoms are the major precursors, leading drug users to share unsterile syringes and needles and thereby increasing the risks of HIV transmission and other health risks. The study also found that IDUs seemed aware and worried about HIV and other health risks, prompting them to devise their own seemingly suitable strategies for harm minimization. Understanding these high-risk strategies should inform public health and intensive harm-reduction services to be considered and implemented in Nepal. Attempts should be made to keep the IDUs in touch with suitable medication-assisted therapies to overcome the withdrawal symptoms, thus minimizing the chance of sharing syringes/needles with other IDUs.