Doing a shotgun: a drug use practice and its relationship to sexual behaviors and infection risk

There has been a rise in the frequency with which inhalational routes such as smoking are used for illicit drug use. A growing population of new inhal ational drug users augments the pool of individuals at risk for transition to injection drug use. Further, illicit drug smoking has been implicated in the transmission of a variety of pathogens by the respiratory route, and c rack smoking has been associated with an increased risk of HIV infection, p articularly through the exchange of high-risk sex for drugs. Shotguns are a n illicit drug smoking practice in which smoked drugs are exhaled or blown by one user into the mouth of another user. We conducted a series of ethnog raphic observations to attempt to characterize more fully the practice of s hotgunning, the range of associated behaviors, and the settings and context s in which this practice occurs. Shotguns maybe seen as a form of drug use which has close ties to sexual behaviors, and which has both pragmatic and interpersonal motivations, combining in a single phenomenon the potential d irect and indirect risk of disease transmission by sexual, blood borne and respiratory routes. These data support the need to develop and evaluate com prehensive risk reduction interventions, which take into consideration the relationships between interpersonal and sexual behaviors and specific forms of drug use. (C) 1999 Elsevier Science Ltd. All rights reserved.