Longitudinal Patterns of Drug Injection Behavior in the ALIVE Study Cohort,1988-2000: Description and Determinants

Abstract

The objective of this study was to characterize longitudinal patterns of drug injection behavior for individuals and to identify their early determinants. Participants were 1,339 injection drug users recruited into the AIDS Link to Intravenous Experience (ALIVE) Study in Baltimore, Maryland, through community outreach efforts. The study was initiated in 1988, and follow-up continued through 2000, with semiannual visits. Patterns of self-reported drug injection (yes/no) were defined for each participant, based on the number of drug-use transitions. The effect of baseline factors was assessed using multinomial logistic regression models. Over the 12-year study period, four patterns were noted: 29% of participants remained persistent drug injectors, 20% ceased injection, 14% relapsed once, and 37% had multiple transitions. Persistent injectors had the shortest follow-up and the highest mortality. For persons who changed their behavior, 3.4 years elapsed before their first cessation attempt, on average. Factors differentiating the groups included history of incarceration, young age, participation in drug treatment programs, recent overdose, and commercial sex. The observed long-term injection patterns are consistent with the view of drug addiction as a chronic disease. This view emphasizes the need for prolonged efforts to sustain cessation and to prevent adverse health and social outcomes among injection drug users.

Attitudes of intravenous drug users in London towards the provision of drug consumption rooms

“…There were no significant differences between the views of those currently injecting compared to those who were not currently injecting on their attitudes regarding the three ethical concerns about DCRs. The views of those no longer injecting are important since, as experienced past injectors, they can provide a particular perspective on how DCRs might have impacted on their own trajectory towards abstinence; moreover, longitudinal studies suggest that significant numbers of abstinent drug users will relapse to injecting drug use (Galai et al, 2003;Hser et al, 2001) including those receiving methadone treatment (Gossop 19 et al, 2003: Termorshuizen et al, 2005. A more recent consideration for those implementing new DCRs is the increase in the smoking of drugs (Hedrich et al, 2010).…”

“…However, Hedrich (2004) argued that these concerns are largely unsubstantiated: as DCRs operate close to drug markets, some drug dealing has inevitably been reported near to them (Hedrich, 2004). The success of DCRs in reducing public nuisance is largely dependent on their opening hours, capacity and location (Hedrich et al, 2010); most have to deal with queues (Woods, 2014 of injecting drug users (IDUs) who were drug free at follow up (Hser et al, 2001;Galai et al, 2003).…”

Estimating the size of the population of persons who inject drugs in the island of Montréal, Canada, using a six-source capture–recapture model

“…Between 1996Between and 2009Between -2010 harm reduction programs, including distribution of sterile injection equipment (Noël and Cloutier, 2009;Noël et al, 2011) OST programs have previously been associated with injection cessation (Goldstein et al, 2000;Galai et al, 2003;Shah et al, 2006;Evans et al, 2009), an increased offer in the island of Montréal may have resulted in a higher rate of injection cessation which could have contributed to the observed reduction of the PWID population. However, the impact of OST programs is limited to opioid users while cocaine is the most often injected drug in the island of Montréal (Leclerc et al, 2013b).…”

Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

“…At the same time, opioid injectors may shift to noninjection forms in search of less risky forms of drug use or as a step in maturing out of their use habits altogether (42). Given the substantially increased levels of risks and harms associated with injection forms of opioid use, both ends of the transition trajectory have enormously important implications for prevention, yet they are little understood or used in interventions (43)(44)(45).…”