Patterns of cocaine and opioid co-use and polyroutes of administration among street-based cocaine users in Montréal, Canada

Abstract

Conclusion:The heterogeneity of consumption patterns supports the importance of offering an array of interventions aimed at problematic cocaine users. These should include the provision of clean injecting and smoking material, the promotion of safe sexual behaviours and the prevention of initiation to drug injection. In the absence of specific treatment, cocaine users should have access to primary health care services and addiction treatment based on innovative behavioral and pharmacological approaches.2

Exploration of a Crack Use Setting and Its Impact on Drug Users’ Risky Drug Use and Sexual Behaviors: The Case ofPiaulesin a Montréal Neighborhood

“…Quite a few people met during the ethnographic fieldwork injected drugs, mostly in a pattern of polyconsumption (cocaine-opiates). Similar observations were made in recent epidemiological studies demonstrating that street-based drug users in Montréal still injected, and that cocaine-opiate co-use (heroin and/or prescription opioids) as well as polyroutes of administration were common Roy et al, 2013). In addition to increased availability of crack, Montréal is witnessing a growing popularity of prescription opioid injection among street-based drug users, which certainly contributes to maintaining injection prevalence in the city (Roy, Arruda & Bourgois, 2011;Roy et al, 2012).…”

“…From a public health perspective, the transformation of "shooting galleries" into drug use settings where only crack can be smoked seems advantageous since shooting galleries have long been associated with injection risk behaviors and drug-related harms (Neaigus et al, 1994;Latkin et al,1994;Klein & levy, 2003;Deren et al, 2004). However, despite the greater presence of crack, some street-based users continue to inject drugs, especially long-term IDUs who persist in injecting cocaine or opiates (prescription opioids or heroin) (Roy, Arruda & Bourgois, 2011;Roy et al, 2012;Roy et al, 2013). Quite a few people met during the ethnographic fieldwork injected drugs, mostly in a pattern of polyconsumption (cocaine-opiates).…”

Rural and urban comparisons of polysubstance use profiles and associated injection behaviors among people who inject drugs in Puerto Rico

“…A three-class solution was identified in the rural sample, and a five-class solution was identified in the urban sample, patterns similar to those found in prior LCA research with PWID (Betts et al, 2016; Harrell et al, 2012; Kuramoto et al, 2011; Meacham et al, 2015; Monga et al, 2007; Roy et al, 2013; Trenz et al, 2013). These patterns across diverse populations of PWID suggests that polysubstance use is normative (rather than restricted to a small subset) within the PWID population—and may reflect a common liability for polysubstance use among heavy substance users everywhere (Vanyukov et al, 2003).…”

Changing patterns of first injection across key periods of the French Harm Reduction Policy: PrimInject, a cross sectional analysis

“…These findings reflect changes in the illegal drug market and confirm the increasing prevalence of stimulant drug use all over Europe (OEDT, 2012 ;EMCDDA et Europol, 2013). Early onset of the use of cocaine and other stimulant drugs and the increasing role of these drugs at first injection are particularly worrisome as cocaine injection behavior is demonstrated to be associated with higher drug use practices (Bourgois et Bruneau, 2000 ;Patrick et al, 2001 ;Tyndall et al, 2003 ;Roy et al, 2013), which increases the probability of HIV and HCV transmission, especially during the sensitive injection initiation period. Given the wide availability of stimulant drugs in the European illegal drug market and their increasing role in drug abuse and maintenance treatment (Guichard et al, 2006 ;Carrieri et al, 2003), the risks associated with the use of cocaine and other stimulants (e.g., through equipment sharing) at the time of first injection deserve further investigation and reaffirm the need of new harm reduction tools for cocaine injectors.…”