Public injecting among a cohort of injecting drug users in Vancouver, Canada

Abstract

The findings indicate that a substantial proportion of local IDUs frequently inject in public, and those who report recently injecting in public spaces appear to be a vulnerable population facing significant health hazards. The provision of secure housing may have the potential to protect the health of IDUs in this setting and significantly decrease the prevalence of public injecting. In addition, the findings support previous work suggesting that removing barriers to the use of Vancouver's existing supervised injection site may serve to further reduce public drug use.

Public drug injecting in London, Ontario: a cross-sectional survey

“…In the Canadian context, high levels of public injecting have been documented among people who inject drugs in Vancouver, [1][2][3] Ottawa, 4 Toronto 5 and Montréal, 6 where 54%-77% of people who inject drugs reported any recent public injecting, and 17%-23% reported injecting predominantly in public. Public injecting poses the risks of discovery by police, robbery and violence.…”

“…[7][8][9] Public injecting tends to be concentrated among the most vulnerable people who inject drugs, being independently associated with homelessness, recent incarceration, high-intensity drug use (e.g., injecting daily or more) and injecting-related risks (e.g., nonfatal overdose, needle-sharing, not cooking and filtering drugs) in several large Canadian cities. [1][2][3][4]6,10,11 At a community level, public injecting is perceived as a threat to public order and contributes to improper disposal of injection-related litter. 12 Although these public health and order challenges posed by public injecting in major urban centres are well-documented, little is known about challenges that public injecting may pose for smaller municipalities.…”

Injection Drug Use Among Homeless Adults With Mental Illness: A Gender-based Analysis

“…Frequent injectors who are homeless have been found to be six times more likely to publicly inject . Injecting in public spaces places individuals at an increased risk for bacterial infections, fatal overdose, and infectious disease due to rushing, unsterile conditions, and syringe sharing (Stoltz, Wood, Small, Li, Tyndall, Montaner, & Kerr, 2007;Aidaila et al, 2005;DeBeck et al, 2009). Mental illness is implicated in high-risk drug behaviours and injection practices, placing IDUs with psychiatric problems at greater risk for infectious disease exposure and transmission (Fitzgerald, Lundgren, & Chassler, 2007;Fischer et al 2006).…”

“…Injection drug users (IDUs) suffer an increased burden of infectious disease, co-morbid health conditions and elevated mortality rates in comparison to the general population (Fischer, Firestone-Cruz, & Rehm, 2006;Spittal, Hogg, Li, Craib, Recsky, Johnston et al, 2007). Further, IDU is linked to a multitude of vulnerabilities and social disadvantages (e.g., poverty, homelessness, mental illness), involvement in high-risk illegal income generating activities (e.g., sex work, drug dealing), and public disorder behaviours (e.g., public injecting), that also contribute to compromised health and well-being (Galea & Vlahov, 2002;Fischer et al, 2006;DeBeck, Shannon, Wood, Li, Montaner, & Kerr, 2007; DeBeck, Small, Wood, Li, Montaner, & Kerr, 2009;Miller, Pearce, Moniruzzaman, Thomas, Christian, Schecter et al, 2011). Consequently, IDUs are a highly marginalised and stigmatised population with multiple and complex needs, yet are hard to reach with mainstream health care services (Ahern, Stuber, & Galea, 2006;Simmonds & Coomber, 2007).…”

“…Studies have demonstrated strong links between homelessness and unstable housing, ie., single-room occupancy (SRO) hotel units, with high intensity drug use, high-risk public injecting practices, increased emergency room (ER) utilisation and adverse health outcomes among IDUs -particularly the contraction of infectious diseases including HIV, hepatitis C (HCV), and hepatitis B (HBV) (Aidala, Cross, Stall, Harre, & Sumartojo, 2005;Shannon, Ishida, Lai, & Tyndall, 2006;Kim, Kerr, Li, Zhang, Tyndall, Montaner et al, 2009;DeBeck et al, 2009). Further, illicit drug use is a precipitating factor for housing loss and residential instability (Brunette, Mueser, & Drake, 2004;Wood, Kerr, Werb, DeBeck, Graham, Lai et al, 2009).…”