title: An ethnographic exploration of the everyday lives of 51 people with heroin use experience in rural Dumfries and Galloway, Scotland
Creators: name: Brown, Josef W.
Publisher: name: University of Glasgow
Year: 2024

description: Scotland has a profound public health crisis related to drug use with the unenviable position of holding the highest drug related deaths rate in Europe. Approximately two to three people die from drug use every day in Scotland. The gravity of this situation warrants immediate, comprehensive and efficacious strategies to address the underlying factors that are contributing to this national crisis. One-fifth of people who use heroin in Scotland live in rural areas. Prevailing research exploring heroin use, however, focuses mainly on urban contexts. This thesis explores the “everyday lives” of rural people who use heroin within context and framework of the then Scottish Drugs Policy, “The Road to Recovery” (2008-2018) (Scottish Government, 2008). It investigates and scrutinises how people who use heroin in a rural setting acquire, administer and finance their heroin use, illuminating the significance of “recovery” from their perspectives. Examining the experiences of people who use heroin within a rural setting, provides an avenue to comprehend how aspects of rural living, such as transportation challenges, employment dynamics and lack of anonymity inherent within rurality, impact, shape and influence their daily realities. People who engage with heroin use in rural settings are notoriously difficult to locate and involve, posing challenges not only for research but policy development and practical interventions specifically targeted at their requirements given the background of the public health crisis.

This thesis presents the findings of a year-long ethnographic research study conducted throughout 2018 in rural Dumfries and Galloway in South-West Scotland. The study employed nonparticipant observation, participant-observation, field notes, and interviews involving 51 people who used heroin and 20 recovery service staff. Braun and Clark’s (2006, 2019) reflexive thematic analysis framework was adopted and adapted to analyse my data, the research aim was to determine how this group perceived their everyday role and place within their rural communities. It explored the unique challenges and opportunities inherent in a rural setting and investigated what recovery means to people who actively use heroin through their lived realities. The analysis uncovered the distinctive and unique experiences of people who use heroin in rural Dumfries and Galloway, highlighting the challenges and opportunities that presented in relation to substance use and recovery. These experiences frequently contradicted themes identified in research undertaken in urban settings.

The findings indicate that participants did not problematise heroin use. Instead, their heroin use was characterised by a high degree of regulation, evidenced from the findings. Regulated heroin use was shaped by accessible and free methadone maintenance treatment prescriptions and the presence of sympathetic and supportive staff within drug recovery services. Their familiarity within their wider communities shielded them in the main from feeling stigmatised and promoted inclusivity and even protection. Exploring this group’s everyday lives uncovered that they were not solely people who engaged with heroin use; they were also employees, partners, friends, and parents, who perceived their lives as “normal”, functional, content and fulfilling despite their long-term heroin use. Without exception they clarified that they were not seeking recovery in the form of abstinence. Instead, they engage with recovery services to access prescription methadone and other benefits provide by these services. Recovery services capitalised on these opportunities to engage in health promotion and education with their “clients.”

Similarities to urban settings were also observed, including similar numbers of people who used heroin per capita, increased poly-drug use, overdose incidents, and increasing drug-related deaths. Distinctive factors were also noted, such as negligible homelessness, widespread adoption of naloxone kits and training, reported low purity of heroin, a high proportion of older people who used heroin, rejection of public heroin use and communal environments during heroin use. Unexpected findings extended to the accessibility of heroin even within the remotest of areas, regulated and controlled use of heroin, reliance on state benefits rather than criminality for cash generation, a decline in heroin use and limited recovery services operating within traditional 9-5 hours five days per week. This thesis makes a meaningful contribution to the literature by exploring the everyday lived experiences of people who use heroin, identifying the unique challenges and opportunities associated with rural substance use and recovery highlighting a new concept termed “recovery inertia”. Above all, it offers a voice to an overlooked and unrepresented population.