Turnock & Mulrooney: Image and Performance Enhancing Drug Usage and Services in Rural Regions
In Exploring the Impacts of Rurality on Service Access and Harm Among Image and Performance Enhancing Drug (IPED) Users in a Remote English Region, Luke A. Turnock (Social and Political Sciences, University of Lincoln, UK) and Kyle J. D. Mulrooney (Humanities, Arts, and Social Sciences, University of New England, Australia) consider the underexplored geographic and cultural impacts of rurality on IPED usage, particularly in relation to access to harm reduction service. Their research draws on the experiences of IPED users in rural England and highlights the need to incorporate cultural and geographic understandings into harm reduction policies.
The article notes that as IPED usage has become more mainstream in recent years, and its subsequent health risks have become matters of public health, harm reduction policies and programs have failed to consider how social geographic and structural factors, including the impacts of rurality/urbanity, affect the usefulness of proposed interventions. To identify both the specific challenges that rurality presents and effective harm reduction responses, the authors draw on a sample of IPED users located in the South-West region of England.
The article identifies four key themes that arose through interviews with IPED users. First, limited access and poor transportation to needle and syringe programs and specialist “steroid clinics,” as few of these establishments exist in remote areas. Second, fears of the stigma attached to “stereotypical” injecting drug users, heightened by small towns’ lack of anonymity. Third, institutional distrust, particularly of the medical community and concern that drug usage noted on one’s “medical record” might limit career options. Fourth, rural cultural ideals of masculinity that celebrate stoicism and self-reliance and may contribute to rural men’s resistance to help-seeking.
Ultimately, the authors identified several important takeaways from their research including that, given the barriers to accessing services, estimates regarding levels of IPED use in rural areas based on harm reduction service statistics are likely unreliable. Also significant was the importance of anonymity and the impact of economic circumstances, as those with means were more likely to be able to travel to urban locales to access both safe needles and safe use information. The article notes a need for continued in-depth research into geographic variations, integrating “place” into IPED research in line with developments in the broader drug-related literatures.
