Declining trends in the rates of assisted injecting: a prospective cohort study

Abstract

BackgroundAssisted injecting has been associated with increased risk of blood-borne infections, overdose, and other harms among people who inject drugs (PWID), particularly women. Given the changing availability of relevant harm reduction interventions in Vancouver, Canada, in recent years, we conducted a gender-based analysis to examine changes in rates and correlates of assisted injecting over time among active PWID.MethodsUsing data from a prospective cohort of PWID in Vancouver, we employed gender-stratified multivariable generalized estimating equations to examine trends in assisted injecting and identify the correlates during two periods: June 2006–November 2009 and December 2009–May 2014.ResultsAmong 1119 participants, 376 (33.6 %) were females. Rates of assisted injecting declined between 2006 and 2014 among males (21.9 to 13.8 %) and females (37.0 to 25.6 %). In multivariable analyses, calendar year of interview also remained independently and negatively associated with assisted injecting among males (adjusted odds ratio [AOR] 0.95, 95 % confidence interval [CI] 0.92–0.99) and females (AOR 0.93, 95 % CI 0.89–0.97). Syringe borrowing remained independently associated with assisted injecting throughout the study period among females (AOR 1.53, 95 % CI 1.10–2.11 during 2006–2009; AOR 2.15, 95 % CI 1.24–3.74 during 2009–2014) and during 2009–2014 among males (AOR 1.88, 95 % CI 1.02–3.48).ConclusionsOur findings demonstrate assisted injecting has significantly decreased for both males and females over the past decade. Nevertheless, rates of assisted injecting remain high, especially among women, and are associated with high-risk behavior, indicating a need to provide safer assisted injecting services to these vulnerable sub-populations of PWID.

Peer-to-peer injection: Demographic, drug use, and injection-related risk factors

“…We also found that receiving injection assistance alone was not significantly associated with either distributive or receptive syringe sharing. This finding differs significantly from prior studies where receiving injection assistance was associated with syringe sharing (Cheng et al, 2016;Lee et al, 2013;Pedersen et al, 2016;Robertson et al, 2010;, HIV infection, and HCV and HIV incidence (Lappalainen et al, 2015;Miller et al, 2002;Spittal et al, 2002). The lack of an association between receiving injection assistance and syringe sharing behaviors could be the result of three things.…”

“…Among PWID interactions, peer-to-peer injection or the practice of giving (provider) or receiving injection assistance (recipient) from another PWID, is an important contributor to health outcomes in this population. Both forms of peer-to-peer injection have been associated with infectious disease risk and other harms related to drug injection including syringe sharing (Carlson, 2000;Fairbairn et al, 2006;Friedman et al, 2002;Kral, Bluthenthal, Erringer, Lorvick, & Edlin, 1999;Lee et al, 2013;Pedersen et al, 2016;Wood et al, 2001), abscesses and soft tissue infections (Lee et al, 2013;Lloyd-Smith et al, 2008), drug overdose (Fairbairn, Small, Van Borek, Wood, & Kerr, 2010), and HIV incidence (Lappalainen, Kerr, Hayashi, Dong, & Wood, 2015;O'Connell et al, 2005;Spittal et al, 2002).…”

Drug consumption rooms: A systematic review of evaluation methodologies

“…The majority of the evaluation papers were published between 2005 and 2011 (Figure ) and most were from Canada (Figure ). Since 2006, more papers described DCR/SIF clients or service operation . Also, after 2006, papers using qualitative methods have spiked including those focused on DCR clients or staff , and on other stakeholders .…”

Women in the 2019 hepatitis C cascade of care: findings from the British Columbia Hepatitis Testers cohort study

“…In other BC population-based analyses, uninterrupted opioid agonist therapy (OAT) was associated with higher likelihood HCV treatment uptake among people who inject drugs after adjusting for sex, yet stimulant use disorder was negatively associated with treatment uptake [ 47 , 48 ]. Research has also demonstrated that gendered power dynamics contribute higher HCV exposure risk for women, such as being second on the needle, requiring help to inject, and needing to negotiate harm reduction with risk for violence [ 49 – 51 ]. Women with lived experience of HCV have highlighted that intersecting experiences of sexism, racism, and discrimination toward women who use injection drugs create significant barriers to accessing healthcare, including addiction treatment [ 27 , 43 ].…”