Sociodemographic Disparities in Access to Addiction Treatment Among a Cohort of Vancouver Injection Drug Users

Abstract

Vancouver's explosive HIV epidemic among injection drug users (IDUs) has received international attention due to the presence of a large needle exchange program. The role of addiction treatment has not been evaluated in this setting. We evaluated factors associated with use of addiction treatment among a prospective cohort of Vancouver IDUs. Addiction treatment was negatively associated with Aboriginal ethnicity and unstable housing, both of which have been associated with HIV infection in previous studies. These findings demonstrate low levels of addiction treatment among Vancouver IDUs and suggest that programs may need to be targeted towards specific populations with poor access.

Keywords:

• addiction treatment
• injection drug use
• HIV/AIDS

Additional information

Notes on contributors

Evan Wood

Evan Wood, Ph.D., is an Assistant Professor in the Department of Health Care and Epidemiology at the University of British Columbia and is a Research Scientist at the British Columbia Centre for Excellence in HIV/AIDS where he is the Principal Investigator of the Vancouver Injection Drug Users Study (VIDUS) cohort and co-Principal Investigator of the Scientific Evaluation of Vancouver's Supervised Injection Sites, which is funded through Health Canada. He is also an elected member of the Board of Directors of the Canadian HIV/AIDS Legal Network. Dr. Wood has extensive research experience in the area of clinical epidemiology, especially in evaluating the treatment of HIV/AIDS, and epidemiologic study design, especially among drug-using populations.

Kathy Li

Kathy Li, M.Sc., received her Masters degree in Statistics at the University of British Columbia in 1998. Her interests include biostatistics and epidemiology. She is currently involved in various projects including the Vancouver Injection Drug User Study and other related observational studies.

Anita Palepu

Anita Palepu, MD, is an Associate Professor, General Internal Medicine, University of British Columbia and a faculty associate at the Centre for Health Evaluation and Outcome Sciences. Her work includes: Evaluating the impact of antiretroviral therapy on HIV/HCV co-infected persons who use alcohol and drugs and examine the role of addiction treatment on adherence and HIV-treatment outcomes; developing and validating quality of life instruments for vulnerable populations such as injection drug users, homeless persons and street youth; and conducting a multi-site evaluation of the health effects of funding for such projects to provide supportive housing for high-needs homeless persons in collaboration with the CIHR-funded REACH3 network. She is also an Associate Scientific Editor for the Canadian Medical Association Journal.

David C. Marsh

David Marsh, M.D., graduated in Medicine from Memorial University of Newfoundland following prior training in neuroscience and pharmacology. In January 2004, Dr. Marsh began serving as the Physician Leader, Addiction Medicine with Vancouver Coastal Health. Prior to relocating to Vancouver he was the Clinical Director, Addiction Medicine at the Centre for Addiction and Mental Health in Toronto and Assistant Professor in the Departments of Psychiatry and Family and Community Medicine, Faculty of Medicine at the University of Toronto. Dr. Marsh's research interests include the integration of pharmacotherapy and psychotherapy in the treatment of substance use disorders and focus primarily on novel interventions for opioid dependence. He is presently the project leader for clinical trials within an Interdisciplinary Health Research Team on Illicit Opiate Dependence in Canada funded by the Canadian Institutes of Health Research and a co-investigator on the North American Opiate Medication Initiative (NAOMI) trial.

Martin T. Schechter

Martin Schechter, M.D., Ph.D., received his M.D. at McMaster University in 1981. Dr. Schechter is a physician/epidemiologist and Professor and Head of the Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia. Dr. Schechter has been involved in AIDS research for 16 years and since 1984, has been Principal Investigator of the Vancouver Lymphadenopathy-AIDS Study. Dr. Schechter is also the National Director of the Canadian HIV Trials Network.

Robert S. Hogg

Robert Hogg, Ph.D., received his Ph.D. in Demography at the Australian National University in 1991. He is the Manager of the Drug Treatment Program and the Director of the Population Health Program at the B.C. Centre for Excellence in HIV/AIDS and is Professor in the Department of Health Care and Epidemiology at the University of British Columbia. His current interests include behavioral and sociodemographic markers of progression to AIDS and health issues of indigenous people.

Julio S. G. Montaner

Julio Montaner, M.D., received his M.D. at the University of Buenos Aires in 1979. He holds a Chair of AIDS Research at the University of British Columbia and is Director of Clinical Activities of the B.C. Centre for Excellence in HIV/AIDS. He is Co-Director of the Canadian HIV Trials Network. Dr. Montaner has provided leadership in developing, implementing, and successfully completing several important international studies including the AVANTI I, CAESAR, and INCAS trials.

Thomas Kerr

Thomas Kerr, Ph.D., is Director of Health Research and Policy at the Canadian HIV/AIDS Legal Network and is a Research Associate at the British Columbia Centre for Excellence in HIV/AIDS, where he a co-investigator of the Community Health and Safety Evaluation (CHASE) Project and the Scientific Evaluation of Vancouver's Supervised Injection Sites. Dr. Kerr has extensive research experience in the areas of health psychology and public health, especially in evaluating programs and treatments designed to address HIV/AIDS and injection drug use.