Public and semi-public injection drug use in Thunder Bay, Ontario: the case for supervised injection services

Abstract

Although public injecting has been studied in large urban centres, little is known about the factors that drive public injecting in remote communities. This study sought to explore public and semi-public injection in Thunder Bay, a remote and mid-sized city in Northwestern Ontario. Peer researchers completed surveys with people who inject drugs. Multivariable logistic regression was used to examine sociodemographic characteristics and behavioural patterns associated with injecting in public or semi-public settings. Among 200 people who inject drugs, 128 (64%) individuals reported engaging in public injection. In multivariable analyses, public injecting was positively associated with age (Adjusted Odds Ratio [AOR], 0.97, 95% Confidence Interval [CI]: 0.97–1.00; p = 0.05), homelessness (AOR 2.34, 95% CI: 1.10–5.02; p = 0.02), sex work (AOR 4.62, 95% CI: 1.37–21.61; p = 0.02), injecting alone (AOR 2.66, 95% CI: 1.19–6.02; p = 0.01), opioid injecting (AOR 3.64, 95% CI: 1.48–9.41; p = 0.05) and cocaine injecting (AOR 4.35, 95% CI: 2.11–9.44). The most frequent reasons for public injecting were proximity to where people buy drugs (59.4%), being too far from home (27.3%), and being homeless (25.8%). Our findings suggest that the scale-up of additional harm reduction programming in Thunder Bay, including supervised injection services, may address public injecting and reduce associated harms in this setting.

Keywords:

• Public injecting
• injection drug use
• harm reduction
• Thunder Bay
• supervised injection services

Acknowledgements

The authors thank our participants as well as the following individuals and organizations for their contributions to our study; Jasmine Cotnam, Jean Bacon (Ontario HIV Treatment Network), Beth Rachlis (formerly Ontario HIV Treatment Network), Cynthia Olsen (Thunder Bay Drug Strategy), Elevate NWO, Shelter House, and People Advocating for Change through Empowerment (PACE). This initiative was led by the Ontario HIV Treatment Network (OHTN) in collaboration with the Thunder Bay Drug Strategy.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This study was funded by the Canadian Institutes of Health Research (CIHR) Centre for REACH in HIV/AIDS 2.0 and Thomas Kerr’s CIHR Foundation Grant (FDN-148476). The funding agencies had no role in the study design, data collection, analyses and interpretation of the data, or preparation of the manuscript.