Injection Drug Use among Street-Involved Youth in a Canadian Setting

Background:Street-involved youth contend with an array of health and social challenges,including elevated rates of blood-borne infections and mortality. In addition, there has beengrowing concern regarding high-risk drug use among street-involved youth, in particular injectiondrug use. We undertook this study to examine the prevalence of injection drug use and associatedrisks among street-involved youth in Vancouver, Canada.Methods:From September 2005 to November 2007, baseline data were collected for the At-RiskYouth Study (ARYS), a prospective cohort of street-recruited youth aged 14 to 26 in Vancouver,Canada. Using multiple logistic regression, we compared youth with and without a history ofinjection.Results:The sample included 560 youth among whom the median age was 21.9 years, 179 (32%)were female, and 230 (41.1%) reported prior injection drug use. Factors associated with injectiondrug use in multivariate analyses included age ≥ 22 years (adjusted odds ratio [AOR] = 1.18, 95%CI: 1.10–1.28); sex work involvement (AOR = 2.17, 95% CI: 1.35–3.50); non-fatal overdose (AOR= 2.10, 95% CI: 1.38–3.20); and hepatitis C (HCV) infection (AOR = 22.61, 95% CI: 7.78–65.70).Conclusion:These findings highlight an alarmingly high prevalence of injection drug use amongstreet-involved youth and demonstrate its association with an array of risks and harms, includingsex work involvement, overdose, and HCV infection. These findings point to the need for a broadset of policies and interventions to prevent the initiation of injection drug use and address the risksfaced by street-involved youth who are actively injecting.