Requiring help injecting among people who inject drugs in Toronto, Canada: Characterising the need to address sociodemographic disparities and substance-use specific patterns
Abstract
Background: Those requiring help injecting are at an elevated risk of injection-related injury and blood-borne infections and are thus a priority group for harm reduction programs. As supervised consumption services (SCS) are scaled-up across Canada, information on those who require help injecting is necessary to inform equitable service uptake. We characterised the sociodemographic, structural and drug use correlates of needing help injecting among a cohort of people who inject drugs in Toronto, Canada.
Methods: A cross-sectional baseline survey was administered between November 2018 and March 2020. Unadjusted and multivariable logistic regression models examined associations with requiring help injecting in the past 6 months. A gender-stratified sub-analysis described characteristics of receiving help among those requiring it.
Results: Of 701 participants (31.0% cisgender women), 294 (41.9%) needed recent help injecting. In unadjusted analyses, being a racialised, non-Indigenous person (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.13–2.86) or a cisgender woman (OR 1.72, 95% CI 1.24–2.39) were associated with needing help. In multivariable analyses, requiring assistance was associated with needing frequent help preparing drugs (adjusted OR [AOR] 9.52, 95% CI 4.78–21.28), fewer years since first injection (AOR for 1 year increase: 0.97, 95% CI 0.95–0.99) and injecting stimulants. Among those who required help, cisgender women reported needing assistance more often than cisgender men (P = 0.009).
Related Content
Preventing Injecting by Modifying Existing Responses (PRIMER)
PRIMER is a multi-country study on the impact of different interventions in preventing people who use drugs from initiating others into injection drug use.
View
Investigating a bidirectional relationship between overdose and provision of injection initiation assistance among persons who inject drugs in Vancouver, Canada and Tijuana, Mexico
To explore a potential relationship between overdose and injection initiation, we assessed temporal associations between experiencing a non-fatal overdose and assisting others in initiating injection drug use among persons who inject drugs in two North American cities - Vancouver, Canada and Tijuana, Mexico.
View
Examining the Gender Composition of Drug Injecting Initiation Events: A Mixed Methods Investigation of three North American Contexts
Using mixed methods across three settings in North America, we investigated the gender composition of injection initiation events and the gendered risk environments in which they occurred.
View
Recent Incarceration and Risk of First-Time Injection Initiation Assistance: A Prospective Cohort Study of Persons Who Inject Drugs
Given the prevalence and harms of incarceration among persons who inject drugs (PWID) and their role in injection drug use initiation, this study aimed to investigate whether recent incarceration influences the likelihood PWID assist others in their first-ever injection.
View
A Fragmented Code: The Moral and Structural Context for Providing Assistance with Injection Drug Use Initiation in San Diego, USA
This study examines the social networks and structural contexts linked with assisting others in initiating injection drug use.
View
Injection Drug Use Trajectories among Migrant Populations: A Narrative Review
This article examines the risk factors for injection drug use initiation that are associated with migration.
View
Increased Non‐fatal Overdose Risk Associated with Involuntary Drug Treatment in a Longitudinal Study with People who Inject Drugs
This article examines the influence of involuntary drug treatment (IDT) on non‐fatal overdose among people who inject drugs (PWID).
View
Do Law Enforcement Interactions Reduce the Initiation of Injection Drug Use? An Investigation in Three North American Settings
This article examines the influence that law enforcement interactions have on the reporting of people who inject drugs (PWID) of assisting others with injection initiation.
View
Cross‐border Migration and Initiation of Others into Drug Injecting in Tijuana, Mexico
This study examines the role of people who inject drugs (PWID) in facilitating the entry of others into injection initiation in settings characterized by cross-border migration that are associated with a unique risk environment.
View
History of Medication-Assisted Treatment and its Association with Initiating Others into Injection Drug Use in San Diego, CA
This article examines whether a history of medication-assisted treatment for people who inject drugs (PWID) is associated with a reduced probability of providing injection initiation assistance.
View
Preventing Injection Drug use Initiation: State of the Evidence and Opportunities for the Future
This article examines the evidence on the prevention of injection initiation to identify emerging intervention strategies and key barriers to effectively controlling the ongoing epidemic.
View
Non-injection Drug Use and Injection Initiation Assistance Among People Who Inject Drugs in Tijuana, Mexico
This article examines the risk factors among people who inject drugs (PWID) for providing assistance to other in injection initiation.
View
The North American Opioid Epidemic: Current Challenges and a Call for Treatment as Prevention
This article explores current challenges to contain the opioid epidemic and calls for various treatments that could reduce the epidemic including the scaling up of medication-assisted treatment (MAT).
View
A Socio-structural Approach to Preventing Injection Drug Use Initiation: Rationale for the PRIMER Study
This study explores the methodology employed in the PRIMER study.
View
From Words to Action: Comparing the Disparities Between National Drug Policy and Local Implementation in Tijuana, Mexico and Vancouver, Canada
This article examines the discrepancies between federal policy and local responses to drug-related harms to understand the impact of national drug policies in shaping local responses to drug-related harms among people who use drugs (PWID).
View