The perception and management of risk by people who use heroin in Hong Kong's 'drug-free' society.

Hong Kong's drug policy is firm in its goal of a 'drug-free' society, implemented through abstinence-based rehabilitation and law enforcement. Heroin use is declining and those who continue to use it are an aging, vulnerable and socially stigmatized population who manage an array of risks with few resources available to them. We conducted semi-structured interviews with older persons who use heroin (n=25), to understand how they perceive and manage drug-related health risks, and the challenges they face. This paper adopts a socially situated paradigm of risk behaviour to analyse how people who use heroin in Hong Kong perceive and manage risks to their health, including: withdrawal, overdose, injection-related infections, polysubstance use and mental health risks. We found that older people who use heroin are generally risk averse and knowledgeable about harm reduction, having cultivated routine risk reduction strategies over their drug using careers. Our socially situated lens reveals that risk perceptions fluctuate, and the acceptability of risk changes over time and in response to context mediated by power dynamics, and access to social and economic capital.