Ascertaining the Need for a Supervised Injecting Facility (SIF): The Burden of Public Injecting in Montreal, Canada

Abstract

Empirical evidence suggests that a key prerequisite for a supervised injection facility (SIF) utilization is the existence of an “open drug scene,” where users publicly inject drugs. This study seeks to determine the extent and profile of public injecting among injecting drug users (IDUs) in Montreal, Canada, where pilot SIFs are under consideration. A cross-sectional study of IDUs who injected publicly at least once in the previous month was appended to an HIV-risk surveillance study among Montreal IDUs (SurvUDI study). Of 650 SurvUDI participants interviewed between June 2001 and February 2002, 59% were eligible. A dose-response relationship emerged between intensity of public injecting and several drug-use and risk-related characteristics. Regardless of housing stability, IDUs persistently and, often preferably, publicly injected due to habit, dependence, or need to conceal their status. Despite lacking a classical open drug scene, public injecting is common among Montreal IDUs, warranting the consideration of an SIF for this population.

Public drug injecting in London, Ontario: a cross-sectional survey

“…The prevalence of any recent public injecting in our sample (71.9%) was comparable to findings among people who inject drugs in Canada's largest cities, 3,5,6 and almost 1 in 2 participants (46.4%) reported that at least one-quarter of their recent injections took place in public or semipublic settings. Consistent with prior research, [1][2][3][4]6 regular public injecting was independently positively associated with homelessness or unstable housing and high-intensity injection of both opioids and crystal methamphetamine. Although neighbourhood of use was not independently associated with public injecting, crude prevalence was significantly higher among those who reported that they usu- …”

“…In the Canadian context, high levels of public injecting have been documented among people who inject drugs in Vancouver, [1][2][3] Ottawa, 4 Toronto 5 and Montréal, 6 where 54%-77% of people who inject drugs reported any recent public injecting, and 17%-23% reported injecting predominantly in public. Public injecting poses the risks of discovery by police, robbery and violence.…”

“…[7][8][9] Public injecting tends to be concentrated among the most vulnerable people who inject drugs, being independently associated with homelessness, recent incarceration, high-intensity drug use (e.g., injecting daily or more) and injecting-related risks (e.g., nonfatal overdose, needle-sharing, not cooking and filtering drugs) in several large Canadian cities. [1][2][3][4]6,10,11 At a community level, public injecting is perceived as a threat to public order and contributes to improper disposal of injection-related litter. 12 Although these public health and order challenges posed by public injecting in major urban centres are well-documented, little is known about challenges that public injecting may pose for smaller municipalities.…”

High rates of homelessness among a cohort of street-involved youth

“…In Canada, injection drug use is reported among approximately 38% and 54% of street youth in Vancouver (Ochnio et al, 2001) and Montreal (Roy et al, 2002) respectively. Interestingly, there remains an absence of data on public injection drug use among street-involved youth, even though public injecting has been associated with extensive harms (e.g., HIV) among more experienced populations of homeless injectors both in our setting (Small et al, 2005) and others (Rhodes et al, 2006;Klein and Levy, 2003;Navarro and Leonard, 2004;Green et al, 2003). Further, given that homeless youth are a "hidden population" often not connected to any traditional health-related system (Feldman and Middleman, 2003;Martijn and Sharpe, 2006), little is known about rates of homelessness and the associated risks among street-involved youth.…”

Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States

“…A complete description of the development and validation of the evaluation tool can be found elsewhere [20]. Briefly, the 16 cases were selected from a pool of 60 unique experiences reported by IDUs as part of a study on public injecting [21]. Eleven medical experts in overdose recognition and treatment were asked to designate each case as either: (i) opioid overdose; (ii) non-opioid overdose; (iii) not an overdose; or (iv) not enough information/unsure, and whether naloxone was indicated.…”