BackgroundAddiction treatment is an effective strategy used to reduce drug-related harm. In the wake of recent developments in novel addiction treatment modalities, we conducted a longitudinal data analysis to examine factors associated with inability to access addiction treatment among a prospective cohort of persons who inject drugs (PWID).MethodsData were derived from two prospective cohorts of PWID in Vancouver, Canada, between December 2005 and November 2013. Using multivariate generalized estimating equations, we examined factors associated with reporting an inability to access addiction treatment.ResultsIn total, 1142 PWID who had not accessed any addiction treatment during the six months prior to interview were eligible for this study, including 364 women (31.9 %). Overall, 188 (16.5 %) reported having sought but were ultimately unsuccessful in accessing addiction treatment at least once during the study period. In multivariate analysis, factors independently and positively associated with reporting inability to access addiction treatment included: binge drug use (Adjusted Odds Ratio [AOR] = 1.65), being a victim of violence (AOR = 1.77), homelessness (AOR = 1.99), and having ever accessed addiction treatment (AOR = 2.33); while length of time injecting was negatively and independently associated (AOR = 0.98) (all p < 0.05).ConclusionsThese findings suggest that sub-populations of PWID were more likely to report experiencing difficulty accessing addiction treatment, including those who may be entrenched in severe drug addiction and vulnerable to violence. It is imperative that additional resources go into ensuring treatment options are readily available when requested for these target populations.

OBJECTIVES Street-involved youth are highly vulnerable to violence. While involvement in income-generating activities within illicit drug scenes are recognized as shaping youths’ vulnerability to violence, the relative contributions of different income-generating activities remain understudied. We sought to examine the independent effects of drug dealing and sex work on experiencing violence among street-involved youth. METHODS Data were derived from a prospective cohort of street-involved youth aged 14–26 who use drugs in Vancouver, Canada, between September 2005 and May 2014. Multivariable generalized estimating equations were used to examine the impact of involvement in drug dealing and sex work on experiencing violence. RESULTS Among 1,152 participants, including 364 (31.6%) women, 740 (64.2%) reported having experienced violence at some point during the study period. In multivariable analysis, involvement in drug dealing but not sex work remained independently associated with experiencing violence among females (adjusted odds ratio [AOR]: 1.43; 95% confidence interval [CI]: 1.08 – 1.90) and males (AOR: 1.50; 95% CI: 1.25 – 1.80), while involvement in sex work only was not associated with violence among females (AOR: 1.15; 95% CI: 0.76 – 1.74) or males (AOR: 1.42; 95% CI: 0.81 – 2.48). CONCLUSION Findings indicate that involvement in drug dealing is a major factor associated with experiencing violence among our sample. In addition to conventional interventions, such as addiction treatment, novel approaches are needed to reduce the risk of violence for drug-using youth who are actively engaged in drug dealing. The potential for low-threshold employment and decriminalization of drug use to mitigate violence warrants further study.