Homelessness and Incarceration Associated With Relapse into Stimulant and Opioid Use among Youth Who Are Street-Involved in Vancouver, Canada

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Goldman-Hasbun J, Nosova E, Thomas K, Wood E, DeBeck K. Homelessness and incarceration associated with relapse into stimulant and opioid use among youth who are street-involved in Vancouver, Canada. Drug and Alcohol Review. 2019; 38(4): 428-434. March 21, 2019. [Epub ahead of print]. PMID: 30896070. DOI: 10.1111/dar.12921

Date created: 
Substance-related disorders
Homeless youth

Introduction and Aims: While much research has sought to identify the factors associated with initiation and cessation of various forms of drug use among vulnerable youth, little is known about relapse into drug use in this population. We sought to characterize relapse into stimulant and opioid use among street-involved youth in Vancouver, Canada.

Design and Methods: Data were collected between 2005 and 2017 from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth who use illicit drugs in Vancouver. Multivariable extended Cox regression was utilized to identify factors associated with relapse into harder drug use among youth who had previously ceased using stimulants and/or opioids for six months or longer.

Results: Among 246 participants who reported a period of cessation lasting six months or longer, 165 (67.1%) relapsed at some point during study follow-up. Youth who were recently incarcerated (adjusted hazard ratio [AHR]: 1.47), homeless (AHR: 1.40), or had a history of daily stimulant use (AHR: 1.64) were significantly more likely to report relapse, while youth of who identified as white (AHR: 0.78) were significantly less likely to report relapse (all p <0.05).

Discussion: Relapse into harder drug use was common among youth in our setting, and incarceration, homelessness, and daily stimulant use (pre-cessation) were found to be positively associated with relapse among street-involved youth.

Conclusions: Findings suggest that increased access to youth housing supports and alternatives to the criminalization of drug use may help to reduce the rates of relapse into harder drugs in this population.


The full text of this paper will be available in May 2020 due to the embargo policies of Drug and Alcohol Review. Contact summit@sfu.ca to enquire if the full text of the accepted manuscript can be made available to you.

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Rights remain with the authors.
Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine
Canadian Institutes of Health Research New Investigator Award
MSFHR/St. Paul's Hospital Foundation–Providence Health Care Career Scholar Award
US National Institutes of Health