Evidence map›Paper›PMID 42561604›Full record

ArticleDrug and alcohol dependence2026

Multilevel drivers and constraints of shifts from injecting to smoking opioids and stimulants: A qualitative study from the San Diego-Tijuana border region.

William H Eger, Maia H Hauschild, Erika L Crable, Logan A Hehner, Katie Bailey, M Gudelia Rangel, Alicia Harvey-Vera, Carlos Vera, Annick Bórquez, Heather A Pines and 4 more

Abstract read
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In one paragraph

Article in Drug and alcohol dependence, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

William H EgerSchool of Social Work, San Diego State University, San Diego, CA, USA; School of Medicine, University of California San Diego, La Jolla, CA, USA. Electronic address: weger0735@sdsu.edu.
Maia H HauschildMiller School of Medicine, University of Miami, Miami, FL, USA. Electronic address: mhh82@med.miami.edu.
Erika L CrableFielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA; Center for Health Policy Research, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: elcrable@ucla.edu.
Logan A HehnerDepartment of Psychology, Hartwick College, Oneonta, NY, USA. Electronic address: hehnerl@hartwick.edu.
Katie BaileyHerbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA. Electronic address: kkbailey@health.ucsd.edu.
M Gudelia RangelDepartment of Population Studies, Colegio de la Frontera Norte, Tijuana, Mexico. Electronic address: grangel2009@gmail.com.
Alicia Harvey-VeraSchool of Medicine, University of California San Diego, La Jolla, CA, USA. Electronic address: alvera@health.ucsd.edu.
Carlos VeraSchool of Medicine, University of California San Diego, La Jolla, CA, USA. Electronic address: cfvera@health.ucsd.edu.
Annick BórquezSchool of Medicine, University of California San Diego, La Jolla, CA, USA. Electronic address: aborquez@health.ucsd.edu.
Heather A PinesHerbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA; School of Public Health, San Diego State University, San Diego, CA, USA. Electronic address: hpines@sdsu.edu.
Eileen V PitpitanSchool of Social Work, San Diego State University, San Diego, CA, USA. Electronic address: epitpitan@sdsu.edu.
Thomas L PattersonSchool of Medicine, University of California San Diego, La Jolla, CA, USA. Electronic address: tpatterson@health.ucsd.edu.
Steffanie A StrathdeeSchool of Medicine, University of California San Diego, La Jolla, CA, USA. Electronic address: sstrathdee@health.ucsd.edu.
Angela R BazziHerbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA; Boston University School of Public Health, Boston, MA, USA. Electronic address: abazzi@health.ucsd.edu.

Funding

Training Program in Substance Use, HIV and Related InfectionsT32DA023356 · NIDA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Natasha Martin, Steffanie A Strathdee · 2007 to 2026
$7.8M
A binational cohort of the intersection between substance use, HIV, and associated comorbidities among people who inject drugs in San Diego, CA U01DA063078 · NIDA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Britt Skaathun, Steffanie A Strathdee · 2025 to 2026
$4.9M
SAIA-PrEP: a systems analysis and improvement approach to optimize PrEP implementation in syringe service programsR01DA056883 · NIDA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI BAZZI, ANGELA ROBERTSON, LAMBDIN, BARROT HOPKINS · 2022 to 2025
$3.4M
In pursuit of a one-stop shop: a hybrid type 1 effectiveness-implementation trial of comprehensive tele-health concierge for people who inject drugsR01DA058352 · NIDA · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · PI Tyler Scott Bartholomew, Hansel Emory Tookes · 2023 to 2026
$2.7M
Determinants of transitioning from injecting to smoking fentanyl and methamphetamine and implications for harm reduction implementationR36DA061013 · NIDA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI EGER, WILLIAM HENRY · 2024 to 2025
$108k
NIDA NIH HHS R01 DA056883NIDA NIH HHS R01 DA058352NIDA NIH HHS R36 DA061013NIDA NIH HHS T32 DA023356NIDA NIH HHS U01 DA063078
6 · The paper itself

Abstract

backgroundAmidst declines in injecting opioids and stimulants across North America, we sought to explore multilevel drivers and constraints of shifts from injecting to smoking these substances among people with a history of injection drug use.

methodsFrom October-December 2024, we conducted semi-structured qualitative interviews with individuals with histories of injection drug use in San Diego, California, and Tijuana, Baja California. Eligibility included past-month heroin, fentanyl, or methamphetamine use by injection and/or smoking. Informed by the social ecological model, we used thematic analysis to examine the multilevel determinants of shifts in routes of drug use.

resultsAmong 36 participants (50% in San Diego), median age was 40 years, 61% were male and 58% were unsheltered. In the past month, 81% both injected and smoked heroin, fentanyl, and/or methamphetamine, 17% smoked only and 3% injected only. Rather than complete substitution, most participants described smoking as their primary route alongside intermittent or situational injection, driven by: (1) desires to avoid fentanyl-related injection harms; (2) greater ease, discretion, and lower stigma of smoking; and (3) drug-supply conditions and fentanyl-methamphetamine co-use. Sustained movement toward smoking was constrained by (4) embodied injection practices and beliefs about desired effects or withdrawal relief and (5) inconsistent access to smoking equipment.

conclusionIndividual shifts toward smoking were often intentional (e.g., to reduce health harms) but depended on drug market conditions and material environments. Expanding access to smoking equipment while maintaining syringe coverage for ongoing injection may reduce harms in the context of fentanyl-methamphetamine co-use.

Indexed as

Analgesics, OpioidCentral Nervous System StimulantsSmokingSubstance Abuse, IntravenousAdultCaliforniaFemaleFentanylHumansMaleMethamphetamineMexicoMiddle AgedQualitative ResearchAnalgesics, OpioidCentral Nervous System StimulantsFentanylMethamphetamineAnalgesics, OpioidDrug OverdoseFentanylMethamphetamineSmokingSubstance Abuse, Intravenous

Identifiers

PMID42561604
PMCPMC13585043

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.