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The Association Between Residential Eviction and Syringe Sharing Among a Prospective Cohort of Street-Involved Youth

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-08-02
Abstract: 

Background: Syringe sharing is a high-risk practice associated with the transmission of infectious diseases, such as HIV and HCV. While youth who contend with housing instability are known to be more likely to engage in high risk substance use, the potential relationship between being evicted from housing and syringe sharing has not been examined. This study assessed whether residential eviction was associated with syringe sharing among street-involved youth in Vancouver, Canada.

Methods: Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use drugs age 14-26 in Vancouver, Canada. The study period was June 2007 to May 2014 and the potential relationship between residential eviction and syringe sharing was analyzed using multivariable generalized estimating equations (GEE) logistic regression.

Results: Among 405 street-involved youth who injected drugs, 149 (36.8%) reported syringe sharing, defined as borrowing or lending a syringe, at some point during the study period. In a multivariable GEE analysis, recent residential eviction remained independently associated with syringe sharing (Adjusted Odds Ratio [AOR] = 1.72, 95% Confidence Interval [CI]: 1.16–2.57), after adjusting for potential confounders.

Conclusions: Syringe sharing was significantly elevated among youth who had recently been evicted from housing. These findings indicate that policy and programmatic interventions that increase housing stability may help mitigate high risk substance use practices among vulnerable youth.

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Article
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Knowledge of Hepatitis C and Treatment Willingness Amongst People Who Inject Drugs in an Era of Direct Acting Antivirals

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-07-27
Abstract: 

Background: Knowledge of hepatitis C virus (HCV) is believed to be important in altering risk behaviour, improving engagement in care, and promoting willingness to initiate HCV treatment. We assessed factors associated with HCV knowledge and treatment willingness amongst people who inject drugs (PWID) in an era of direct acting antivirals.

Methods: Data were derived from three prospective cohort studies of PWID in Vancouver, Canada, between June 2014 and May 2015. HCV knowledge and treatment willingness were assessed using a Likert scale. Multivariable linear regression identified factors associated with higher HCV knowledge and treatment willingness.

Results: Amongst 630 participants, mean scores for HCV knowledge and treatment willingness were 25.41 (standard deviation [SD]: 2.52) out of 30, and 6.83 (SD: 1.83) out of 10, respectively. In multivariable analyses, Caucasian ancestry (adjusted linear regression model estimate [β] 0.50; 95% confidence interval [CI] 0.17, 0.82), employment (β 0.76; 95% CI: 0.38, 1.13), diagnosed mental health disorder (β 0.44; 95% CI: 0.11, 0.78) and previous HCV treatment (β 0.94; 95% CI: 0.46, 1.43) were independently associated with higher knowledge. Downtown Eastside (DTES) residence (i.e., epicenter of Vancouver’s drug scene) was independently associated with lower knowledge (β -0.48; 95% CI: -0.81, -0.15). Greater HCV knowledge (β 0.12; 95% CI: 0.07, 0.17) was independently associated with higher HCV treatment willingness. DTES residence (β -0.31; 95% CI: -0.56, -0.06) and daily crack cocaine smoking (β -0.52; 95% CI: -0.92, -0.13) were independently associated with lower treatment willingness.

Conclusion: Socioeconomic factors, such as neighborhood residence and employment, were associated with HCV knowledge. Higher HCV knowledge was associated with more HCV treatment willingness. Our findings suggest that increasing HCV knowledge amongst PWID may be an integral component of the HCV cascade of care and that efforts might be best targeted to individuals with greater socioeconomic disadvantage.

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Article
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Increasing Availability of Benzodiazepines Among People Who Inject Drugs in a Canadian Setting

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-07-27
Abstract: 

Background: Benzodiazepine misuse is associated with mortality and is common among people who inject drugs (PWID). This study aimed to examine the temporal trends in the availability of benzodiazepines among PWID in a Canadian setting, and to identify factors associated with more immediate access to benzodiazepines.

Methods: Data were derived from three prospective cohorts of PWID in Vancouver, Canada, between June 2012 and May 2015. The primary outcome was the perceived availability of benzodiazepines, measured in three levels: not available, delayed availability (available in ≥10 min), and immediate availability (available in <10 min). We used multivariable generalized estimating equations to identify factors associated with availability of benzodiazepines.

Results: In total, 1641 individuals were included in these analyses. In multivariable analyses, factors associated with immediate benzodiazepine availability included incarceration (adjusted odds ratio (AOR): 1.42, 95% CI1.06, 1.89) and participation in methadone maintenance therapy (MMT) (AOR: 1.35, 95% CI 1.14, 1.60). Factors associated with delayed benzodiazepine availability included incarceration (AOR: 1.45, 95% CI 1.02, 2.07) and MMT (AOR: 1.77, 95% CI 1.48, 2.12). Benzodiazepine availability increased throughout the study period for both immediate (AOR: 1.14, 95% CI 1.10, 1.18 per 6-month follow-up period) and delayed availability (AOR: 1.17, 95% CI 1.12, 1.22 per 6-month follow-up period).

Conclusions: Among our sample of PWID, benzodiazepine availability is increasing and was associated with health and criminal justice system characteristics. Our findings indicate a need to examine prescribing practices and educate both PWID and healthcare providers about the risks associated with benzodiazepine use.

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Article
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Intentional Cannabis Use to Reduce Crack Cocaine Use in a Canadian Setting: A Longitudinal Analysis

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-07-25
Abstract: 

Background: No effective pharmacotherapies exist for the treatment of crack cocaine use disorders. Emerging data suggests that cannabinoids may play a role in reducing cocaine related craving symptoms. This study investigated the intentional use of cannabis to reduce crack use among people who use illicit drugs (PWUD).

Methods: Data were drawn from three prospective cohorts of PWUD in Vancouver, Canada. Using data from participants reporting intentional cannabis use to control crack use, we used generalized linear mixed-effects modeling to estimate the independent effect of three predefined intentional cannabis use periods (i.e., before, during and after first reported intentional use to reduce crack use) on frequency of crack use.

Results: Between 2012 and 2015, 122 participants reported using cannabis to reduce crack use, contributing a total of 620 observations. In adjusted analyses, compared to before periods, after periods were associated with reduced frequency of crack use (Adjusted Odds Ratio [AOR] = 1.89, 95% Confidence Interval [CI]: 1.02–3.45), but not the intentional use periods (AOR= 0.85, 95% CI: 0.51–1.41). Frequency of cannabis use in after periods was higher than in before periods (AOR = 4.72, 95% CI: 2.47–8.99), and showed a tendency to lower frequency than in intentional cannabis use periods (AOR = 0.56, 95% CI: 0.32–1.01).

Conclusions: A period of intentional cannabis use to reduce crack use was associated with decreased frequency of crack use in subsequent periods among PWUD. Further clinical research to assess the potential of cannabinoids for the treatment of crack use disorders is warranted.

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Article
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Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-07-27
Abstract: 

Previous research indicates that criminalization of sex work is associated with harms among sex workers. In 2013, the Vancouver Police Department changed their sex work policy to no longer target sex workers while continuing to target clients and third parties in an effort to increase safety of sex workers (similar to “end-demand sex work” approaches being adopted in a number of countries globally). We sought to investigate the trends and correlates of rushing negotiations with clients due to police presence among 359 sex workers who use drugs in Vancouver before and after the guideline change. Data were derived from three prospective cohort studies of people who use drugs in Vancouver between 2008 and 2014. We used sex-stratified multivariable generalized estimating equation models. The crude percentages of sex workers who use drugs reporting rushing client negotiations changed from 8.9% before the guideline change to 14.8% after the guideline change among 259 women, and from 8.6% to 7.1% among 100 men. In multivariable analyses, there was a significant increase in reports of rushing client negotiation after the guideline change among women (p=0.04). Other variables that were independently associated with increased odds of rushing client negotiation included: experiencing client-perpetrated violence (among both men and women) and non-heterosexual orientation (among women) (all p<0.05). These findings indicate that despite the policing guideline change, rushed client negotiation due to police presence appeared to have increased among our sample of female sex workers who use drugs. It was also associated with client-perpetrated violence and other marker of vulnerability. These findings lend further evidence that criminalizing the purchase of sexual services does not protect the health and safety of sex workers.

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Article
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Cessation of Injecting and Preceding Drug Use Patterns Among a Prospective Cohort of Street-Involved Youth

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-07-27
Abstract: 

Purpose: Injection drug use is prevalent among street-involved youth, but patterns of cessation are poorly described. We identified drug use patterns preceding injection cessation among street-involved youth.

Methods: From September 2005 to May 2015, we collected data from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada, and limited the sample to actively injecting youth. The primary outcome was cessation of injecting self-reported at semiannual follow-up visits. We used Cox regression to identify drug use patterns preceding cessation.

Results: Among 383 youth, 65% were male, mean age was 22.3 (SD, 2.5; range, 15-30) years, and 171 (45%) ceased injecting for 6 months or more (crude incidence density 22 per 100 person-years; 95% confidence interval [CI], 19-26). Youth who ceased were less likely to have injected daily (adjusted hazard ratio [AHR], 0.40; 95% CI, 0.28-0.56), injected heroin (AHR, 0.40; 95% CI, 0.29-0.56), or injected crystal methamphetamine (AHR, 0.43; 95% CI, 0.31-0.59) prior to cessation. Non-injection heroin use was positively associated with injection cessation (AHR, 1.52; 95 CI, 1.12-2.08). Addiction treatment was not associated with cessation. At the time of cessation, 101 (59%) youth continued to use ‘hard’ non-injection drugs such as heroin and crystal methamphetamine.

Conclusions: Periods of injection cessation were common but frequently accompanied by ongoing non-injection drug use. Findings indicate that trajectories of injection drug use among youth are complex and highlight the need to further explore relationships between ongoing non-injection drug use and injection cessation.

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Article
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“Getting Out of Downtown”: A Longitudinal Study of How Street-Entrenched Youth Attempt to Exit an Inner City Drug Scene

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-07-25
Abstract: 

Background: Urban drug “scenes” have been identified as important risk environments that shape the health of street-entrenched youth. New knowledge is needed to inform policy and programing interventions to help reduce youths’ drug scene involvement and related health risks. The aim of this study was to identify how young people envisioned exiting a local, inner city drug scene in Vancouver, Canada, as well as the individual, social and structural factors that shaped their experiences.

Methods: Between 2008 and 2016, we draw on 150 semi-structured interviews with 75 street entrenched youth. We also draw on data generated through ethnographic fieldwork conducted with a subgroup of 25 of these youth between.

Results: Youth described that, in order to successfully exit Vancouver’s inner city drug scene, they would need to: (a) secure legitimate employment and/or obtain education or occupational training; (b) distance themselves – both physically and socially – from the urban drug scene; and (c) reduce their drug consumption. As youth attempted to leave the scene, most experienced substantial social and structural barriers (e.g., cycling in and out of jail, the need to access services that are centralized within a place that they are trying to avoid), in addition to managing complex individual health issues (e.g., substance dependence). Factors that increased youth’s capacity to successfully exit the drug scene included access to various forms of social and cultural capital operating outside of the scene, including supportive networks of friends and/or family, as well as engagement with addiction treatment services (e.g., low threshold access to methadone) to support cessation or reduction of harmful forms of drug consumption.

Conclusions: Policies and programming interventions that can facilitate young people’s efforts to reduce engagement with Vancouver’s inner-city drug scene are critically needed, including meaningful educational and/or occupational training opportunities, ‘low threshold’ addiction treatment services, as well as access to supportive housing outside of the scene.

Document type: 
Article

Perceived Devaluation and STI Testing Uptake among a Cohort of Street-involved Youth in a Canadian Setting

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-07-25
Abstract: 

Perceived devaluation has been shown to have adverse effects on the mental and physical health outcomes of people who use drugs. However, the impact of perceived devaluation on sexually transmitted infections (STI) testing uptake among street-involved youth, who face multiple and intersecting stigmas due to their association with drug use and risky sexual practices, has not been fully characterized. Data were obtained between December 2013 and November 2014 from a cohort of street-involved youth who use illicit drugs aged 14–26 in Vancouver, British Columbia. Multivariable generalized estimating equations were constructed to assess the independent relationship between perceived devaluation and STI testing uptake. Among 300 street-involved youth, 87.0% reported a high perceived devaluation score at baseline. In the multivariable analysis, high perceived devaluation was negatively associated with STI testing uptake after adjustment for potential confounders (Adjusted Odds Ratio = 0.38, 95% Confidence Interval 0.15–0.98). Perceived devaluation was high among street-involved youth in our sample and appears to have adverse effects on STI testing uptake. HIV prevention and care programs should be examined and improved to better meet the special needs of street-involved youth in non-stigmatizing ways.

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Article
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History of Being in Government Care Associated with Younger Age at Injection Initiation Among a Cohort of Street-involved Youth

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-07-25
Abstract: 

Introduction and Aims: Compared to the general population of youth, health-related disparities experienced by youth exposed to the child welfare system are well documented. Amongst these vulnerabilities are elevated rates of substance use, including injection drug use; however, less is known about when these youth transition to this high-risk behaviour. We sought to assess whether having a history of government care is associated with initiating injection drug use before age 18.

 

Design and Methods: Between September 2005 and May 2014, data were derived from the At-Risk Youth Study, a cohort of street-involved youth who use illicit drugs in Vancouver, Canada. Multivariable logistic regression analysis was employed to examine the relationship between early initiation of injection drug use and having a history of being in government care.

 

Results: Among the 581 injecting street-involved youth included, 229 (39%) reported initiating injection drug use before 18 years of age. In multivariable analysis, despite controlling for a range of potential confounders, having a history of government care remained significantly associated with initiating injection drug use before age 18 (adjusted odds ratio = 1.69; 95% confidence interval: 1.15–2.48).

 

Discussion and Conclusions: Youth with a history of being in government care were significantly more likely to initiate injection drug use before age 18 than street-involved youth without a history of being in care. These findings imply that youth in the child welfare system are at higher-risk and suggest interventions are needed to prevent transitions into high-risk substance use among this population.

Document type: 
Article
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