The Growing Popularity of Prescription Opioid Injection in Downtown Montréal: New Challenges for Harm Reduction

Abstract

Starting in 2007, a 2-year study based on ethnographic methodology was carried out downtown Montréal, Canada. A thematic analysis of observational and interview-based notes was conducted. Illicit prescription opioid (PO) use was widespread among street-based participants. Injection was the main mode of PO administration observed among users. Some injection practices such as “doing a wash” could pose new challenges in terms of prevention of infections. More research is needed to examine the role of illicit PO use in the development of opiate addiction and to better understand drug-using contexts that put PO users at risk of infections. The study's limitations are noted.

RÉSUMÉ

La popularité grandissante de l'injection d'opiacés médicamenteux au centre-ville de Montréal: nouveaux défis en réduction des méfaits

Une étude ethnographique été menée entre 2007 et 2009 au centre-ville de Montréal, Canada. L'analyse thématique des notes d'observation et d'entrevue a montré que la consommation illicite d'opiacés médicamenteux était répandue dans le milieu. L'injection était le mode principal de consommation utilisé. Certaines pratiques d'injection telle que celle de “faire un wash” pourraient poser de nouveaux défis pour la prévention des infections. D'autres recherches permettront d'examiner le rôle de la consommation illicite d'opiacés médicamenteux dans le développement de l'assuétude aux opiacés et de comprendre les contextes favorisant les risques d'infection chez les usagers. Les limites de l’étude sont présentées.

RESUMEN

La progresiva popularidad de la inyección de opioides prescritos en el centro de Montreal: nuevos desafíos para la reducción de daños

Un estudio etnográfico fue llevado a cabo entre los años 2007 y 2009 en el centro de Montreal, Canadá. El análisis temático de las notas de observación y de las entrevistas mostró un extenso consumo ilícito de opioides prescritos entre los participantes del estudio. La inyección es la principal forma de consumo de opioides prescritos. Algunas practicas de inyección tal como la de “hacer un wash” podrían crear nuevos retos en la prevención de infecciones. Futuros estudios son necesarios para examinar el rol del consumo de opioides prescritos en el desarrollo de la dependencia a los opioides y entender los contextos que pueden incrementar el riesgo de infecciones en los consumidores. Los límites del estudio son enunciados.

• Keywords prescription opioid
• injection drug use
• street-based drug user
• Montréal
• injection practices
• ethnography

THE AUTHORS

Élise Roy, M.D., M.Sc., is a public health physician. She is the director of the Addiction Unit of the Faculty of Medicine and Health Sciences at University of Sherbrooke and the chairholder of the Chair in Addiction Research funded by the University, the Charles Lemoyne Hospital Foundation, and the University of Sherbrooke Foundation in Québec, Canada. She is also at the Montréal Public Health Department. She is the author of 50 articles and several scientific reports and book chapters on drugs, HIV, hepatitis C, and street-involved youth. She is currently involved in observational and intervention studies among street-based drug users. She is the coprincipal investigator of a research team on cocaine use, mental health, and HIV and HCV risks and of a prospective cohort study on HIV and HCV risks among injection drug users. Her research work combines both qualitative and quantitative methods.

Nelson Arruda, M.Sc., has a Master's degree in Anthropology from the Université de Montréal. He is an independent researcher whose main research interest is the risk environment of street-based drug users. He is currently the principal ethnographer on a project documenting changing patterns of drug use where he has been conducting participant observation fieldwork among street-based drug injectors and crack smokers in downtown Montréal.

Philippe Bourgois, Ph.D., is the Richard Perry University Professor of Anthropology and Family & Community Medicine at the University of Pennsylvania. He is the author of over 150 articles on drugs, violence, labor migration, ethnic conflict, and urban poverty, as well as several books, including the multiple award winning, In Search of Respect: Selling Crack in El Barrio and also Righteous Dopefiend. He is currently conducting participant-observation fieldwork in North Philadelphia on the health risk environment in the Puerto Rican community. He is a member of the editorial board of Substance Use and Misuse.

Notes

1 Price chart (CDN). Dilaudid®: 1 mg = $1.25, 2 mg = $2.50, 4 mg = $5, and 8 mg = $10; Hydromorph Contin®: 3 mg = $2.50, 6 mg = $5, 12 mg = $10, 24 mg = $20, and 30 mg = $25.