Society For The Study Of Addiction

QMJC Oct 2017 – Initiating Injection Drug Use

Paper under discussion:

The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis

Andy Guise, Danielle Horyniak, Jason Melo, Ryan McNeil & Dan Werb (2017)  Addiction, 112, 1-14

In the October Qualitative Methods Journal Club we discussed the above titled paper, authored by Andy Guise and colleagues. The QMJC attracted researchers from a range of backgrounds, including MSc students, doctoral candidates and post-doctoral researchers. The paper was slightly different to the empirical research papers we have previously discussed, as it presented the process of systematically synthesising qualitative literature to identify the socio-structural contexts and experiences leading to the initiation of injection drug use.

Overall, our discussions focussed on the synthesis of qualitative literature. We collectively concluded that the paper was well written, clear, and provided in-depth insights into a topic area that researchers still do not know a great deal about.

The introduction clearly presents the background and rationale for synthesising qualitative literature in the addiction field and includes a range of relevant references. The authors explicitly stated their primary aim and sub-questions, and draw upon existing social and structural theoretical frameworks to position the review. The introduction also neatly positioned why a qualitative literature review was needed – to complement quantitative data that demonstrates relationships between individual, social and structural factors, but does not offer reasons why or how these relationships occur. Furthermore, the authors state how a developed understanding of injection drug use initiation could inform health interventions and policy decisions.

The methods were clear and succinct. Members thought that it was good that the literature search included social science-focussed databases alongside health databases. The group thought that the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram was a helpful way of showing where the literature was found and how it was identified (i.e. databases, hand searching, expert searching and bibliography searching). In addition, the QJC liked the use of the Critical Appraisal Skills Programme (CASP) to support the interpretation and development of the analysis. However, it was commented that it was not clear how the CASP score translated into a study being classified as ‘low’, ‘medium’ or ‘high’ quality.

Thematic synthesis was used to develop concept and theory relevant to policy and intervention development. We felt that the approach to thematic synthesis was transparent and clearly explained. The authors provide a good level of detail about the process of conducting thematic synthesis by coding and grouping the data, firstly into descriptive themes, and then into analytical themes to explain and explore the descriptive themes. Members, (in particular those with less familiarity with qualitative analytical procedures), welcomed the inclusion of figure 2 which was seen a helpful way of visualising the process of data synthesis, and showed how the conceptual, analytical themes were rooted in the data from the individual papers.

The QMJC really liked the structure of the results. Members felt that there was a clear overview of the study characteristics, which showed the global distribution of studies included in the review and the range of qualitative research designs used. The summary table of included papers provided good level of detail and helped us to appreciate the range of studies included in the review. The group were impressed with the concise synthesis of data from 41 papers into an accessible results section. We liked how the results highlighted similarities and differences across a range of circumstances, settings and populations (e.g. women).

We thought that the discussion neatly brought together the main themes and highlighted areas for future research. The discussion considered the relevance for policy, and recommended that research and policy makers should seek to understand and create ‘socio-structural environments’ in which vulnerable individuals have ‘alternative, attractive choices’ to initiate injection drug use, rather than focus on harm reduction through individual behaviour change. We felt that this highlighted the benefit of conducting a qualitative synthesis, involving individual, social and structural factors, to more fully understand drug injection initiations. The authors are transparent about the review’s limitations and draw a concise conclusion.

Dr Tom Parkman, Dr Ranjita Dhital and Dr Charlotte Tompkins, Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London.

You may also like….

Critical Appraisal Skills Programme (2017) 10 Questions to help you make sense of qualitative research. Available at:

Notley, C., Blyth, A., Craig, J., Edwards, A. & Holland, R. (2015) Postpartum smoking relapse – a thematic synthesis of qualitative studies. Addiction 110(11):1712-23.

Thomas, J. & Harden, A. (2008) Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology 8:45.

The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.