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

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.