Social-structural factors influencing periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada: an ethno-epidemiological study

Abstract

BackgroundInjection drug use is associated with HIV and hepatitis C transmission, overdose, and other preventable harms. These harms are heightened for structurally vulnerable injection drug-using populations, as their social conditions pose barriers to safer injecting. Previous research on injection cessation has largely focused on adult drug-using populations. Little qualitative work has examined the social, structural, and environmental factors that shape periods of injection cessation among youth and young adults. Such research is essential to understanding how we can best reduce harms among this vulnerable population as they move in and out of periods of injection cessation.MethodsWe conducted 22 semi-structured, qualitative interviews with street-involved young people who use drugs (SY), focused on characterizing their transitions into periods of injection cessation and perceived barriers to injection cessation. Adopting an ethno-epidemiological approach, participants who had experienced at least 6 months of injection cessation were purposively recruited from an ongoing prospective cohort study of SY in Vancouver, Canada to participate in qualitative interviews. Qualitative interview findings were triangulated with the findings of a longitudinal program of ethnographic research with SY in this setting. This ethno-epidemiological approach allowed for a more robust exploration of contextual factors surrounding drug use patterns than would be possible through traditional epidemiological methods alone.ResultsFindings indicate that periods of injection cessation were influenced by access to harm reduction-informed youth-focused services, transitions in route of administration (e.g., from injecting methamphetamine to the smoking of methamphetamine), and the provision of housing and social supports (e.g., from friends, family, and care providers). Conversely, participants indicated that inadequate social supports and, for some, abstinence-focused treatment methods (e.g., 12-step programs), impeded efforts to cease injecting.ConclusionsTo reduce harms, it is imperative to reorient attention toward the social, structural, and spatial contexts that surround injection drug use and shape periods of injection cessation for SY. There is an urgent need for more comprehensive youth-focused services for those engaged in injection drug use, and further study of innovative means of engaging youth.

Marginalization: Conceptualizing patient vulnerabilities in the framework of social determinants of health—An integrative review

“…During marginalization, there is an increase in both the perceived and objective distance to resources such that there is differential access to, and inequity in education, employment, housing and affordable health care services (see Figure ). For instance, an ethno‐epidemiologic study that examined social, structural, and environmental factors that influence periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada, found that access to harm reduction youth‐focused services, provision of housing, and social support were important factors that influenced injection cessation (Boyd et al., ). A participant in this study reported his residential location in Vancouver's inner‐city drug scene limited his ability to escape the drug scene.…”

Social and structural barriers for adherence to methadone maintenance treatment among Vietnamese opioid dependence patients

“…They included lower socioeconomic status, lack of social support, discrimination and insufficient methadone doses [ 26 – 30 ]. Meanwhile, some structural barriers were also recognized to predict non-adherence to MMT including patients’ satisfaction with healthcare services, poverty, jobs and housing, in both developed and developing countries [ 19 , 23 , 24 , 28 , 31 – 33 ]. However, these factors varied across study settings, and very few ones have focused on the provision of MMT in relation to other HIV services.…”

Intensive Models of Hepatitis C Care for People Who Inject Drugs Receiving Opioid Agonist Therapy

“…Despite the central role PWID occupy in the HCV epidemic, few are offered DAA treatment because of concerns regarding suboptimal adherence, cost, and medication resistance (12,13). People who inject drugs face many adherence challenges, including mental illness, homelessness, lack of positive social support, poor adherence-related skills, low HCVrelated knowledge, and poor access to and mistrust of the health care system (14)(15)(16)(17). Yet, most PWID with HCV are willing to undergo treatment (18)(19)(20)(21), and the simplicity of DAA therapy promises great advantages for achieving HCV cure.…”