Why Should ‘We’ Stop Saying ‘Public Injecting’?
The latter half of 2016 saw increased interest and positive development with regard to the introduction of Safer Injecting Facilities (SIF) in both Scotland and the Republic of Ireland. Whether or not this interest proves to be yet another false policy promise in the progress of UK harm reduction remains to be seen. However, during this period of potential development, I couldn’t help but notice that advocates of SIF stated that such facilities would aim to reduce local levels of ‘public injecting’ and assist with ‘removing drug-use from the street’.
In addition, I have also noted that since 2016 there have been over a dozen academic publications (in academic journals) that use the term ‘public injecting’ in the title/abstract; or refer to public injecting as an aspect of the paper in question. (This can be easily checked by searching ‘public injecting’ in Google Scholar). Whilst I fully understand the term and what it means (the injecting of illicit substances in public toilets, car parks, park areas etc), I now believe it is an expression that needs to be reviewed and used less frequently! In addition, I recommend that it is time that ‘we’ (academics, service providers, policy makers, harm reduction advocates) completely stop using this term as a result of the ambiguity implicit within the term ‘public injecting’.
This may seem like an unusual, contradictory and/or somewhat hypocritical recommendation from a person who has built a research career on studying/describing the social, physical and environmental circumstances underlying ‘public injecting’ in a variety of English towns and cities during 2006-2014. However, as I explained in a recent guest lecture (at Liverpool John Moores University), when I commenced my doctoral research on this issue in 2006, I was picking-up on an internationally ‘established term’ that had been established several years earlier by leading academics in the field of harm reduction / HIV/AIDS. At that point in time (2006), as a naïve researcher in the actual world of ‘public injecting’, I did not have the confidence to question/dismiss a term that had been established in academic circles by more senior (and internationally renowned) researchers. For these reasons, I blindly and unquestioningly reproduced the term in a large of body of published and unpublished work during 2006-2012 as would be expected of a less senior academic.
Around 2012-2013, I began dropping the term ‘public injecting’ to describe the preparation/injecting of illicit drugs in public or semi-public places. Instead, I began using the term ‘street-based injecting’ to describe the exact same act of preparing / injecting drugs in public / semi-public places. My reasons for this were informed by two recurring themes that had emerged during 3 periods of research in 4 different English towns and cities (2006-2011). These issues related to the way in which ‘public injecting’ was variously (mis)understood by commissioners, practitioners, service providers and people who inject drugs in various locations. It was only after several years of working in the field that I fully recognised that the term ‘public injecting’ was an ambiguous expression and interpreted very differently within different audiences. Indeed, it was only after working in multiple areas throughout England that I fully appreciated that the term is open to subjective interpretation by whoever hears the words ‘public injecting’ – and especially so by those actually working within public health or actually affected by substance use.
To illustrate, when I raised the issue of ‘public injecting’ with some commissioners, service providers, frontline staff and drug/alcohol commissioner groups, a typical response was that ‘we don’t have public injecting in (insert name of town here)’. In return, I regarded such responses with some degree of scepticism and/or incredulity as I found it hard to believe that ‘public injecting’ did not take place in the towns/cities concerned. However, during a conversation with a Director of Public Health in May 2012, it suddenly dawned on me that all those previous denials of ‘public injecting’ were possibly premised upon a misunderstanding of ‘public injecting’ itself. More accurately, this misunderstanding was possibly connected to an (incorrect) assumption that I had been asking questions about the type of open, communal injecting drug use once associated with places such as Platzspitz Park (the so-called ‘Needle Park’ in Zurich during the 1980s-90s). From the perspective of those completely detached from, or only partially connected to, frontline services, it is perhaps reasonable to see why ‘public’ in the term ‘public injecting’ was regarded in such spatial terms (namely, with a view that prioritises social location). While this may seem as a somewhat frivolous point, it does have important consequences. For example, those wishing to develop harm reduction services (or seek finances from commissioner groups) on the topic of ‘public injecting’ may face immediate obstacles if the term is viewed as irrelevant to the local setting. To discuss the topic with such groups more in terms of ‘street-based injecting’ perhaps diminishes this ambiguity and perhaps makes more explicit an activity that will almost certainly take place in any town/city where substances can be acquired for injection!
In addition to the above, I also opted to use the term ‘street-based injecting’ following my experiences in recruiting PWID during the initial stages of my work on this topic. I submitted a full account of this matter to this website sometime in 2013 (see Careful Words on Common Ground; link here?). In short, I quickly noted that using the term ‘public injecting’ with service users and PWID was a form of expression that was loaded with ‘stigma’ and ‘shame’. In making the term less explicit by emphasising an interest in places of injecting drug use (rather than the public nature of these same places) I found it much easier for research participants to describe their (often harmful) experiences of street-based injecting. Accordingly, for PWID and drug/alcohol service users, it is possible that the term ‘public injecting’ is one that emphasises the activity more in relational terms (a view that prioritises contact with other people; the general public). As such, to discuss harms and hazards associated with the more explicit ‘street-based injecting’ is more likely to produce meaningful conversations with this group than a term that is loaded with stigma and shame (‘public injecting’).
For the above reasons, since 2012-13, I have preferred to use the term ‘street-based injecting’ to describe what is widely known as ‘public injecting’. I believe that in using this preferred term, I am being overt and explicit to all audiences that read/hear the word. In addition, I suggest that street-based injecting is a less ambiguous term to certain audiences and less shameful to yet other audiences. I believe that the term ‘street-based injecting’, (with its overt emphasis upon ‘place’), removes the potential for misunderstanding by competing audiences (who may confuse spatial and/or relational understandings attached to the ‘public’ within ‘public injecting’). It is thus for these reasons that I suggest we (within the field of harm reduction) should stop using the term ‘public injecting’ in debates of harm and hazard associated with street-based injecting drug use. …. And especially with regard to disseminating understandings of Safer Injecting Facilities that have been proven to save so many lives in other international settings.
Stephen is a Research Fellow at the National Addiction Centre at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. His most notable ethnographic work relates to a multi-site study of street-based injecting drug, drug-related litter and associated harm and hazard from the perspectives of people who inject drugs and frontline staff who encounter such issues in their daily employment. The views expressed in this article are those of the author and do not necessarily reflect those of his employer.