Cessation of Injecting Drug Use Among Street-Based Youth

Abstract

Young injecting drug users (IDUs) are at high risk for a number of negative health outcomes such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) infection. However, very little is known about injecting drug-use patterns among this population, particularly with respect to cessation of injection. We sought to identify the factors associated with cessation of injection in a population of young street-based IDUs. A prospective cohort study design was used to assess long-term (> or = 1 year) cessation of drug injection. Data was collected between January 1995 and September 2000 in Montreal, Québec, Canada. Subjects were originally recruited from various street-based outreach programs in Montreal and, for this study, had to have reported injecting drugs within the prior 6 months at baseline or during follow-up and had to have completed at least two semiannual follow-up questionnaires. Cessation incidence rates stratified by duration of injection and adjusted hazard ratios (AdjHRs) were calculated. A Cox proportional hazards regression model was used to identify risk factors independently associated with cessation of drug injection. Of 502 young IDUs, 305 subjects met the inclusion criteria. Cessation of injection for approximately 1 year or more occurred in 119 (39%) of the young IDUs. The incidence of cessation was 32.6/100 person-years but consistently declined as duration of time spent injecting increased. Independent predictors of cessation of injection were currently injecting on a less than monthly or less than weekly basis (HR = 6.4; 95% confidence interval (CI): 3.0-13.6 and HR = 2.4; 95% CI = 1.1-5.3, respectively); currently injecting two or fewer different types of drug (HR = 2.1; 95% CI = 1.1-4.0); currently employed (HR = 1.7; 95% CI = 1.1-2.7); and having at least one parent born outside of Canada (HR = 1.4; 95% CI = 1.1-1.7). Independent predictors of not ceasing injection were currently attending a needle-exchange program (HR = 0.5; 95% CI = 0.3-0.8); and current homelessness (HR = 0.6; 95% CI = 0.4-1.0). The early sharp decline in cessation of drug injection followed by a consistent decrease in this rate suggest difficulties in breaking the habit later on in the drug injecting career. Intensity of drug use and factors which may help to stabilize the social environment of the young IDU may also influence the ability to stop injecting.

Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities

“…9,10 These studies show that younger age, stable housing, employment, HIV seropositivity, abstinence from alcohol, having a lower frequency of injecting, and not having a PWID sex partner are all predictive of cessation of injection drug use. 7,8,[11][12][13][14] Aside from these factors, having depressive symptoms, a history of incarceration or involvement in illicit or marginal activities, such as sex work, or having a partner involved in illegal activities lowers the likelihood of stopping injection drug use. 7,10,11,15,16 Some of these characteristics also predict relapse: younger age, homelessness, HIV seropositivity, use of alcohol, and sexual abstinence are associated with a shorter time to injection relapse.…”

A Method to Estimate Total Entry to Hard Drug Use: The Case of Intravenous Drug Use in Norway

“…Noninstitutional periods of abstinence, induced, e.g., by positive or negative life events, may also occur. In a study from Baltimore, the one year or longer cessation rate was 32.6 per 100 person-years [33] . Another, much smaller, figure was cited by Langendam et al [34] , who found a one-year cessation rate of 4.1 per 100 person-years, varying with calendar time.…”

“…Based on the literature, a lasting cessation rate, including mortality, was set at 5 per 100 person-years from 1980 to 1988, then was supposed to gradually increase to 6 per 100 person-years in 1998 and 1999, and then to decrease to 5.5 per 100 person-years in 2004 and onwards. The rate of temporary cessation was set at 15 per 100 person-years, combining unpublished results from a Norwegian 8-year follow-up study with the mean value from the results of the international studies [33][34][35][36]42] . In addition, a proportion of individuals starting ST was added to the temporary cessation.…”

Masthead

“…For example, studies in Vancouver and Montreal indicated that 41% and 60% of youth, respectively, reported prior injection drug use Roy et al 2007). Factors found to be associated with increased injection drug use included being older than 22 years, involvement in survival sex and hepatitis C infection ), suggesting that the length of time on the street leads to a hierarchy of increasingly risky behaviour and heightened difficulty stopping behaviours such as injection drug use (Steensma et al 2005). Substance use, in particular, is very common form of risky behaviour and is associated with high rates of mortality in street youth populations (Roy et al 2004).…”

“…The longer the time that youth spend on the street, the greater the chance that they will engage in high-risk behaviours, such as prostitution, suicide attempts (McCarthy and Hagan 1992), substance abuse and injection drug use (Steensma et al 2005); these behaviours ultimately increase the risk of chronic homelessness (Goering et al 2002). Further, the longer youth stay on the street, the more they are likely to experience mental health challenges and to define themselves as street youth with limited opportunities for the future and diminishing expectations of leaving the street (Yonge Street Mission 2009).…”