High-Intensity Drug Use and Health Service Access Among Street-Involved Youth in a Canadian Setting

Abstract

Background/Objectives: Addiction severity has been associated with numerous social- and health-related harms. This study sought to examine the prevalence and correlates of high-intensity drug use among street-involved youth in a Canadian setting with a focus on high-risk drug use practices and health service access.

Methods: Data were derived from the At-Risk Youth Study, a Vancouver-based prospective cohort of street-involved youth aged 14–26. We used generalized estimating equations to examine variables associated with high-intensity drug use, defined as daily use of crack cocaine, cocaine, heroin, or crystal methamphetamine. Results: From September 2005 to November 2012, of 1017 youth included in the analyses, 529 (52%) reported high-intensity drug use as defined above at least once during the study period. In a multivariate analysis, older age (Adjusted Odds Ratio [AOR] = 1.47); residing in the Downtown Eastside of Vancouver (AOR = 1.46); homelessness (AOR = 1.30); recent incarceration (AOR = 1.25); inability to access addiction treatment (AOR = 1.42); and crack pipe sharing and/or used syringe injecting (AOR = 2.64), were all positively and independently associated with high-intensity drug use (p < 0.05). The most common barrier to accessing addiction treatment reported by these youth was long waiting lists. Conclusions: High-intensity drug use among street-involved youth was prevalent and associated with structural and geographical disadvantages in addition to high-risk drug administration practices. Youth reporting more frequent drug use also reported barriers to accessing addiction treatment, highlighting the need to expand addiction services tailored to youth at greatest risk of harm from illicit drug use and street-involvement.

Keywords:

• street-involved youth
• high-intensity drug use
• syringe sharing
• health service access barriers
• addiction treatment

THE AUTHORS

Mark Phillips, BSc, is a Research Assistant with the Urban Health Research Initiative (UHRI) in Vancouver. Mark is currently placed with the At-Risk Youth Study (ARYS) conducting study interviews with street-involved youth. His areas of interest for research include substance misuse and risk behavior among street-involved youth.

Lindsey Richardson, DPhil, is a Research Scientist with UHRI at the BC Centre for Excellence in HIV/AIDS (BC-CfE), an Assistant Professor in the Department of Sociology at the University of British Columbia and a Michael Smith Foundation for Health Research Scholar. Lindsey is a medical sociologist whose research focuses on the determinants and consequences of employment, prohibited income generation and socioeconomic marginalization among people who use illicit drugs. Her mixed-methods research includes observational studies, structural intervention implementation and evaluation, and health research participation in addictions research.

Evan Wood, MD, PhD, ABIM, FRCPC, Dip. ABAM, is a Senior Research Scientist at BC-CfE, Director of BC-CfE's UHRI, attending physician at St. Paul's hospital, and Professor in the Department of Medicine at the University of British Columbia. Dr. Wood is also the Medical Director for Addiction Services at Vancouver Coastal Health and the founding Director of the St. Paul's Hospital Goldcorp Addiction Medicine Fellowship, Canada's first interdisciplinary medical education fellowship training program in addiction medicine. He has been widely involved in evaluating illicit drug policies with a special focus on injection drug use. He has coauthored over 450 scientific papers and has received international recognition for his research.

Paul Nguyen, PhD, is a Statistician with UHRI and the Gender & Sexual Health Initiative at BC-CfE. He completed a postdoctoral fellow at the University of Toronto and Cancer Care Ontario in 2012, where his training focused on the spatial modeling of rare diseases.

Thomas Kerr, PhD, is a Senior Research Scientist at BC-CfE, the codirector of UHRI at BC-CfE, and Associate Professor in the Department of Medicine at the University of British Columbia (Division of AIDS). In his role at BC-CfE, Dr. Kerr is a principal investigator of several large cohort studies, 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. Dr. Kerr has published more than 435 scientific papers in international peer-reviewed journals and has received numerous awards for his contributions to public health, human rights, and the fight against HIV/AIDS.

Kora DeBeck, PhD, is a Research Scientist with UHRI at BC-CfE, Assistant Professor in the School of Public Policy at Simon Fraser University and Principal Investigator of ARYS. She is also a Michael Smith Foundation for Health Research/St. Paul's Hospital Foundation-PHCRI Career Scholar and CIHR New Investigator. Dr. DeBeck's research interests involve informing and evaluating health and policy interventions to reduce health and social harms among vulnerable drug using populations, with a focus on street-involved youth.