Crystal methamphetamine and initiation of injection drug use among street-involved youth in a Canadian setting

Abstract

Interpretation: Noninjection use of crystal methamphetamine predicted subsequent injection initiation, and crystal methamphetamine was the most commonly used drug at the time of first injection. Evidence-based strategies to prevent transition to injection drug use among crystal methamphetamine users are urgently needed.

Preventing Injection Drug use Initiation: State of the Evidence and Opportunities for the Future

“…Childhood sexual abuse and trauma [22], the noninjection use of certain drugs (including, importantly, prescription opioids) [13,23,24], and behaviors such as polydrug use [25] have all been identified as individuallevel risk factors that increase the risk of injection initiation. Further, the efficiency afforded by injection vs. non-injection of drugs has been identified as a key motivator for transitions into initiation, particularly among individuals experiencing endemic poverty and during periods when the price of illegal drugs increases [26][27][28][29][30][31].…”

“…One way to address both of these factors is by reducing exposure to, and positive modeling of, injecting behaviors among injection-naive persons. This is likely needed because the existing empirical literature demonstrates that not only is exposure to injection drug use associated with initiation episodes [13,24,28,[36][37][38] but also because these behaviors are associated with requests for initiation made by injection-naive persons [17]. This suggests that injection drug use can be defined as a behavior influenced by interpersonal, group, and broader social processes (with some experts characterizing it as a socially communicable process [28]).…”

“…Specifically, studies of people who facilitate initiation suggest that they are generally more experienced with injecting [39] and have been exposed to or interacted intimately with other PWID as a result of homelessness or incarceration [13]. These intimate interactions with PWID that lead to injection initiation range, according to the literature, from family members, inmates within prison settings, Bhit doctors^(i.e., individuals who assist others with injection for a fee), sexual partners, drug dealers, and friends [24,[40][41][42][43][44]. Further, evidence suggests that the role of Binitiator^is often integrated into other drug scene roles such as providing safer injecting education or assistance with injections [39].…”

“…Instead, the research to date suggests that exposure to injecting and initiation may be associated in multiple ways: injection-naive persons may observe injection or hear PWID speak positively about it [19,24,37]; PWID may act as sources of injection education [19,28]; and PWID may also directly assist individuals with injection during their initiation events [39,45].…”

“…Indeed, individuals who inject drugs will not necessarily experience all or even some of these behaviors or conditions prior to their initiation of injecting. By contrast, there is a nearconsensus across scientific studies that exposure to injection drug use is a key risk factor for injection initiation (though it appears an insufficient cause in isolation) [19,21,24,[40][41][42][43][44]. The growing understanding of these mechanisms has two major implications for the prevention of HIV and viral hepatitis.…”