Journal
BMJ OPEN
Volume 11, Issue 8, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/bmjopen-2020-046957
Keywords
substance misuse; public health; epidemiology; public health; statistics & research methods
Categories
Funding
- US National Institute on Drug Abuse Avenir Award [DP2-DA040256-01]
- Ontario Ministry of Research, Innovation and Science
- Canadian Institutes of Health Research
- NIDA [U01DA021525, R37 DA019829, R01DA031074, U01DA038886]
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This study aimed to assess factors influencing PWID in providing IDU initiation assistance in different North American settings and to generate pooled measures of risk. Findings revealed a higher risk of providing assistance with IDU initiation among individuals with a history of assisting IDU initiations and those recently stopped by law enforcement, while a lower risk was associated with recent opioid agonist treatment (OAT) enrolment and no recent IDU.
Objectives People who inject drugs (PWID) play an integral role in facilitating the entry of others into injection drug use (IDU). We sought to assess factors influencing PWID in providing IDU initiation assistance across three distinct North American settings and to generate pooled measures of risk. Design We employed data from three PWID cohort studies participating in PReventing Injecting by Modifying Existing Responses (PRIMER), for this cross-sectional analysis. Setting Tijuana, Mexico; San Diego, USA; Vancouver, Canada. Participants A total of 2944 participants were included in this study (Tijuana: n=766, San Diego: n=353, Vancouver: n=1825). Measurements The outcome was defined as recently (ie, past 6 months) assisting in an IDU initiation event. Independent variables of interest were identified from previous PRIMER analyses. Site-specific multiple modified Poisson regressions were fit. Pooled relative risks (pRR) were calculated and heterogeneity across sites was assessed via linear random effects models. Results Evidence across all three sites indicated that having a history of providing IDU initiation assistance (pRR: 4.83, 95% CI: 3.49 to 6.66) and recently being stopped by law enforcement (pRR: 1.49, 95% CI: 1.07 to 2.07) were associated with a higher risk of providing assistance with IDU initiation; while recent opioid agonist treatment (OAT) enrolment (pRR: 0.64, 95% CI: 0.43 to 0.96) and no recent IDU (pRR: 0.21, 95% CI: 0.07 to 0.64) were associated with a lower risk. We identified substantial differences across site in the association of age (I-2: 52%), recent housing insecurity (I-2: 39%) and recent non-injection heroin use (I-2: 78%). Conclusion We identified common and site-specific factors related to PWID's risk of assisting in IDU initiation events. Individuals reporting a history of assisting IDU initiations, being recently stopped by law enforcement, and recently injecting methamphetamine/speedball were more likely to have recently assisted an IDU initiation. Whereas those who reported not recently engaging in IDU and those recently enrolled in OAT were less likely to have done so. Interventions and harm reduction strategies aimed at reducing the harms of IDU should incorporate context-specific approaches to reduce the initiation of IDU.
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