Harmful Microinjecting Practices Among a Cohort of Injection Drug Users in Vancouver Canada

Abstract

Objectives: We sought to identify factors associated with harmful microinjecting practices in a longitudinal cohort of IDU. Methods: Using data from the Vancouver Injection Drug Users Study (VIDUS) between January 2004 and December 2005, generalized estimating equations (GEE) logistic regression was performed to examine sociodemographic and behavioral factors associated with four harmful microinjecting practices (frequent rushed injecting, frequent syringe borrowing, frequently injecting with a used water capsule, frequently injecting alone). Results: In total, 620 participants were included in the present analysis. Our study included 251 (40.5%) women and 203 (32.7%) self-identified Aboriginal participants. The median age was 31.9 (interquartile range: 23.4–39.3). GEE analyses found that each harmful microinjecting practice was associated with a unique profile of sociodemographic and behavioral factors. Discussion: We observed high rates of harmful microinjecting practices among IDU. The present study describes the epidemiology of harmful microinjecting practices and points to the need for strategies that target higher risk individuals including the use of peer-driven programs and drug-specific approaches in an effort to promote safer injecting practices.

RÉSUMÉ

Pratiques dangereuses de micro-injection parmi une cohorte d’utilisateurs de drogues injectables à Vancouver, au Canada

Objectifs: Cerner les facteurs associés aux pratiques dangereuses de micro-injection dans une cohorte longitudinale d’utilisateurs de drogues injectables (UDI). Méthodologie: Les chercheurs ont utilisé des données de la Vancouver Injection Drug Users Study (Étude sur les utilisateurs de drogues injectables à Vancouver, VIDUS) recueillies entre janvier 2004 et décembre 2005 et ont effectué une régression logistique basée sur des équations généralisées d’estimation (EGE) afin d’examiner des facteurs sociodémographiques et behavioraux liés à quatre pratiques dangereuses de micro-injection (injections rapides fréquentes, emprunt fréquent de seringues, injection fréquente au moyen d’une capsule d’eau usagée, injection fréquente en solitaire). Résultats: Au total, les chercheurs ont inclus 620 participants dans l’analyse. L’étude comprenait 251 femmes (40,5%) et 203 personnes se désignant comme Autochtones (32,7%). L’âge médian était de 31,9 ans (fourchette interquartile: 23,4–39,3). Les analyses par EGE ont révélé que chaque pratique dangereuse de micro-injection était associée à un profil unique de facteurs sociodémographiques et behavioraux. Discussion: Nous avons constaté des taux élevés de pratiques dangereuses de micro-injection parmi les UDI. Cette étude décrit l’épidémiologie de ces pratiques et montre le besoin d’adopter des stratégies qui ciblent les personnes à risque élevé. Ces stratégies comprendraient des programmes dirigés par les pairs et des initiatives axées sur des drogues particulières, dans le but de promouvoir des pratiques d’injection plus sécuritaires.

RESUMEN

Práctica nociva de microinyección entre un grupo de consumidores de drogas inyectables en Vancouver, Canadá

Objetivos: Identificar los factores asociados a la práctica nociva de microinyecciones en un estudio longitudinal de un número de consumidores de drogas inyectables (CDI) Métodos: Utilizando datos del Vancouver Injection Drug Users Study (Estudio de Consumidores de Drogas Inyectables en Vancouver) (VIDUS), entre enero 2004 y diciembre 2005, se realizó una regresión logística de ecuaciones generalizadas de estimación (EGE), para examinar los factores sociodemográficos y de comportamiento asociados a cuatro prácticas nocivas de microinyecciones (inyecciones apuradas frecuentes, préstamo frecuente de jeringas, inyecciones frecuentes con cápsula de agua usada, inyecciones frecuentes en solitario). Resultados: En total, 620 personas participaron del presente estudio; incluyendo 251 (40.5%) mujeres y 203 (32.7%) personas auto definidas como indígenas. La edad promedio fue de 31.9 años (rango intercuartilla 23.4–39.3). Los análisis de EGE revelaron que cada práctica nociva de microinyección estaba asociada a un perfil exclusivo de factores sociodemográficos y de comportamiento. Debate: Se constataron altos porcentajes de prácticas nocivas de microinyecciones entre consumidores de drogas inyectables CDI. Este estudio describe la epidemiología de estas prácticas nocivas de microinyección y muestra la necesidad de adoptar estrategias que apunten a aquellos individuos de alto riesgo. Esto, incluiría programas dirigidos por sus pares y enfoque específico de drogas, con el fin de promover prácticas de inyección más inocuas.

Keywords :

• injection drug use
• harmful
• Vancouver
• microinjecting practices

THE AUTHORS

Beth Rachlis is currently a PhD candidate in Epidemiology at the Dalla Lana School of Public Health at the University of Toronto. She holds a Master's degree in Epidemiology from the University of British Columbia where she examined risk behaviours associated with injection drug use. Her current research interests include global health, access to health services, and HIV/AIDS.

Elisa Lloyd-Smith's background is in bacterial and viral infectious diseases among injection drug users. Her dissertation work focused on cutaneous injection-related infections. She is currently working in surveillance as an infectious disease epidemiologist in the areas of HIV and hospital-associated infections.

Will Small (M.A.), is an ethnographic researcher who conducts fieldwork examining the health of injection drug users in Vancouver's Downtown Eastside. He coordinates the qualitative research program at the Urban Health Research Initiative within the British Columbia Centre for Excellence in HIV/AIDS. His previous research has examined the impact of incarceration upon the health of injection drug users, and investigated the influence of a supervised injection facility upon access to health services.

Diane Tobin is a member of The Vancouver Area Network of Drugs Users (VANDU), group of drug users and former users who work to improve the lives of people who use illicit drugs through user-based peer support and education. Diane is also member of VANDU's Injection Support Team (IST) which provides education and support to people who cannot inject themselves.

Dave Stone is a member of The Vancouver Area Network of Drugs Users (VANDU) is a group of users and former users who work to improve the lives of people who use illicit drugs through user-based peer support and education.

Dr. Kathy Li has been working on statistical methodology and analyses in the health study of injection drug users and the epidemiology of HIV and HCV infection in this population. Over the past decade she has applied and developed a variety of analytical strategies in the longitudinal cohort study. She has contributed and coauthored over 150 scientific publications in this field.

Evan Wood, MD, PhD, is Co-director of the Urban Health Research Initiative at the British Columbia Centre for Excellence in HIV/AIDS, and a Clinical Associate Professor in the Department of Medicine at the University of British Columbia (Division of AIDS). He has extensive research experience in the area of clinical epidemiology, especially in evaluating the treatment of HIV/AIDS, addiction, and epidemiologic study design, especially among injection drug using populations. Dr. Wood is a physician epidemiologist with a long history of involvement in the healthcare issues facing Vancouver's Downtown Eastside. Dr. Wood's current research focuses on the prevention and treatment of HIV infection among injection drug users. Dr. Wood has published more than 280 scientific papers and has received national recognition of his work. In 2007 Dr. Wood was the recipient of a leadership award from the Canadian Medical Association. Most recently he was the recipient of the 2010 British Medical Journal International Junior Doctor of the Year Award. He is an Associate Editor of the International Journal of Drug Policy, and is Assistant Editor of Addiction. Dr. Wood serves on the editorial boards of a host of addiction and infectious disease journals

Dr. Thomas Kerr is the Director of the Urban Health Research Initiative at the British Columbia Centre for Excellence in HIV/AIDS, Assistant Professor in the Department of Medicine at the University of British Columbia (Division of AIDS), as well as a Michael Smith Foundation for Health Research Scholar. In his role at the British Columbia Centre for Excellence in HIV/AIDS, Dr. Kerr is a principal investigator of several large cohort studies involving people who inject drugs and individuals living with HIV/AIDS, including the Vancouver Injection Drug Users Study (VIDUS). Dr. Kerr's primary research interests are HIV/AIDS, injection drug use, health policy and service evaluation, and community-based research methods. A key focus of Dr. Kerr's work has been the scientific evaluation of Insite, North America's first safer injecting facility, and his research in this area has contributed significantly to academic, public, and government discussion, both nationally and internationally. Dr. Kerr has published over 210 scientific papers in international peer-reviewed journals and has received local and national awards for his contribution to public health, including the National Knowledge Translation Award from the Canadian Institutes of Health Research for his efforts to promote scientific discussion on the links between drug policy and HIV/AIDS.