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Showing posts with label Supervised Injection Facility. Show all posts
Showing posts with label Supervised Injection Facility. Show all posts
Monday, May 9, 2016
Wednesday, December 30, 2015
Use of a Medically Supervised Injection Facility among Street Youth
Purpose
Supervised injecting
facilities (SIFs) provide a sanctioned space for injection drug users and are
associated with decreased overdose mortality and HIV risk behaviors among
adults. Little is known about SIF use among youth. We identified factors
associated with use of the Vancouver SIF, the only such facility in North
America, among street youth.
Methods
From September 2005 to May
2012, we collected data from the At-Risk Youth Study (ARYS), a prospective
cohort of street youth in Vancouver, Canada. Eligible youth were aged 14–26
years. Participants reporting injection completed questionnaires at baseline
and semiannually. We used generalized estimating equation logistic regression
to identify factors associated with SIF use.
Results
During the study period,
42.3% of 414 injecting youth reported use of the SIF at least once. Of all
SIF-using youth, 51.4% went to the facility at least weekly, and 44.5% used it
for at least one-quarter of all injections. SIF-using youth were more likely to
live or spend time in the neighborhood surrounding the SIF, to inject in public, or to engage in daily injection of heroin, cocaine, or crystal
methamphetamine.
Conclusions
This study, the first
examining SIF use among street youth in North America, demonstrated that the
facility attracted high-frequency young drug users most at risk of blood-borne
infection and overdose, and those that otherwise inject in public spaces.
TABLE 1
Characteristicsa of 414 actively injecting youth, according to use of a supervised injection facility (SIF) in the preceding 6 months: At-Risk Youth Study (ARYS), Vancouver, British Columbia, 2005–2012.
| Recent SIF Use | ||||
|---|---|---|---|---|
| Characteristic | Yes (%) (n = 175) | No (%) (n = 239) | OR (95% CI) | p Value |
| Sociodemographic factors | ||||
| Median age, years (IQR) | 23.4 (21.5, 25.1) | 22.7 (20.4, 24.5) | 1.14 (1.05 – 1.22) | 0.003 |
| Male | 112 (64.0) | 162 (67.8) | 0.85 (0.56 – 1.27) | 0.422 |
| Aboriginal ancestry | 45 (25.7) | 50 (20.9) | 1.31 (0.83 – 2.07) | 0.252 |
| High school education | 67 (40.4) | 94 (39.8) | 1.02 (0.68 – 1.53) | 0.915 |
| Spent time in DTESc,d | 143 (81.7) | 114 (47.7) | 4.90 (3.09 – 7.76) | <0.001 |
| Homelessd | 127 (73.0) | 179 (75.2) | 0.89 (0.57 – 1.39) | 0.610 |
| Incarceratedd | 45 (25.9) | 51 (21.4) | 1.28 (0.81 – 2.03) | 0.293 |
| Sex workd | 24 (13.7) | 33 (13.8) | 0.99 (0.56 – 1.75) | 0.978 |
| Drug use-related behaviors | ||||
| Daily heroin injectiond | 76 (43.4) | 49 (20.5) | 2.98 (1.93 – 4.59) | <0.001 |
| Daily cocaine injectiond | 11 (6.3) | 5 (2.1) | 3.14 (1.07 – 9.20) | 0.029 |
| Daily crystal meth injectiond | 36 (20.6) | 34 (14.2) | 1.56 (0.93 – 2.62) | 0.089 |
| Overdosed | 29 (16.6) | 40 (16.7) | 0.99 (0.59 – 1.67) | 0.965 |
| Dealt drugsd | 94 (53.7) | 115 (48.1) | 1.25 (0.85 – 1.85) | 0.261 |
| Any public injectiond,e | 129 (73.7) | 147 (65.0) | 1.51 (0.98 – 2.33) | 0.063 |
| Needed help injectingd | 56 (32.0) | 90 (40.0) | 0.71 (0.47 – 1.07() | 0.099 |
| Visited crack house or shooting galleryd | 65 (39.9) | 67 (29.8) | 1.56 (1.02 – 2.39) | 0.038 |
| Borrowed syringed | 29 (16.6) | 42 (18.7) | 0.87 (0.51 – 1.46) | 0.586 |
| ‘Jacked up’ by policed | 68 (39.3) | 90 (38.0) | 1.06 (0.71 – 1.58) | 0.784 |
| Received drug treatmentd | 68 (39.3) | 80 (33.8) | 1.27 (0.85 – 1.91) | 0.248 |
aFor the 175 youth who reported SIF use, characteristics are shown for the first visit (baseline or follow-up) at which SIF use was reported; for 239 who never reported SIF use, characteristics are shown for the first visit at which injection drug use was reported
bPrior completion of or current enrollment in high school
cLived or spent time in the Downtown Eastside neighborhood, the area immediately surrounding Vancouver's SIF
dDuring the preceding six months
eOn the street, in a public bathroom, or in a park
Full article at: http://goo.gl/SQIrpR
By:
1Boston Children’s Hospital, Division of
Adolescent and Young Adult Medicine, Department of Medicine, 300 Longwood
Avenue, Boston, MA, USA, 02115
2Harvard Medical School, Department of
Pediatrics, 25 Shattuck St., Boston, MA, USA, 02115
3British Columbia Centre for Excellence in
HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC,
Canada, V6Z 1Y6
4Simon Fraser University, School of Public
Policy, SFU Harbour Centre, 515 West Hastings Street, Suite 3271, Vancouver,
BC, Canada, V6B 5K3
5University of British Columbia, Faculty of
Medicine, 317 - 2194 Health Sciences Mall, Vancouver, BC, Canada, V6T 1Z3
Send correspondence to: Evan Wood, MD, PhD, BC
Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 – 1081 Burrard
Street, Vancouver, BC, Canada V6Z 1Y6, Phone: (604) 806-9116, Fax: (604)
806-9044, Email: ac.cbu.tenefc@we-irhu
More at: https://twitter.com/hiv
insight
Saturday, December 26, 2015
Negotiating Place & Gendered Violence in Canada’s Largest Open Drug Scene
Background
Vancouver’s Downtown
Eastside is home to Canada’s largest street-based drug scene and only
supervised injection facility (Insite). High levels of violence among men and
women have been documented in this neighbourhood. This study was undertaken to
explore the role of violence in shaping the socio-spatial relations of women
and ‘marginal men’ (i.e., those occupying subordinate positions within the drug
scene) in the Downtown Eastside, including access to Insite.
Methods
Semi-structured qualitative
interviews were conducted with 23 people who inject drugs (PWID) recruited
through the Vancouver Area Network of Drug Users, a local drug user
organization. Interviews included a mapping exercise. Interview transcripts and
maps were analyzed thematically, with an emphasis on how gendered violence
shaped participants’ spatial practices.
Results
Hegemonic forms of
masculinity operating within the Downtown Eastside framed the everyday violence
experienced by women and marginal men. This violence shaped the spatial practices
of women and marginal men, in that they avoided drug scene milieus where they
had experienced violence or that they perceived to be dangerous. Some men
linked their spatial restrictions to the perceived 'dope quality' of
neighbourhood drug dealers to maintain claims to dominant masculinities while
enacting spatial strategies to promote safety. Environmental supports provided
by health and social care agencies were critical in enabling women and marginal
men to negotiate place and survival within the context of drug scene violence.
Access to Insite did not motivate participants to enter into “dangerous” drug
scene milieus but they did venture into these areas if necessary to obtain
drugs or generate income.
Conclusion
Gendered violence is
critical in restricting the geographies of men and marginal men within the
street-based drug scene. There is a need to scale up existing environmental
interventions, including supervised injection services, to minimize violence
and potential drug-related risks among these highly-vulnerable PWID.
...Women commonly spoke of the additional risks of violent
sexual assault. For example, one woman in her late twenties who engaged daily
in outdoor sex work noted:
I’ll smoke [crack cocaine] in the alley and I
hate it…It’s scary. Anybody could walk up behind you with something and beat
you and try to rob you ‘cause they want your drugs. It’s just scary…I’ve been
raped [in an alleyway].
Gendered violence was understood to be a natural consequence
of drug scene involvement, and thus operated as a form of symbolic violence.
Many participants expressed that this normalized, gendered violence was most
evident in the expectation that dominant men would seek to control the money
and drugs or labour (e.g., contexts in which they exchanged sex) of women and
marginal men. For example, as one older man noted during his interview:
The girls make the money [through involvement in sex
work]. Guys know they got the money. The guys don’t make money, and that
way they have to beg, borrow or steal in between cheques…So, of course they [women] are
going to be manipulated…These guys, you know, [are] muscling them or doing
anything to get what they’ve got [i.e., drugs or money]...
Full article at:
By:
1BC Centre for Excellence in HIV/AIDS,
Vancouver, British Columbia, Canada
2Department of Medicine, University of
British Columbia, Vancouver, British Columbia Canada
3Vancouver Area Network of Drug Users,
Vancouver, British Columbia, Canada
4Faculty of Health Sciences, Simon Fraser
University, Burnaby, British Columbia, Canada
More at: https://twitter.com/hiv_insight
Self-Reported Changes in Drug Use Behaviors & Syringe Disposal Methods Following the Opening of a Supervised Injecting Facility in Copenhagen, Denmark
Background
In Denmark, the first
standalone supervised injecting facility (SIF) opened in Copenhagen’s Vesterbro
neighborhood on October 1, 2012. The purpose of this study was to assess
whether use of services provided by the recently opened SIF was associated with
changes in injecting behavior and syringe disposal practices among people who
inject drugs (PWID). We hypothesized that risk behaviors (e.g., syringe
sharing), and unsafe syringe disposal (e.g., dropping used equipment on the
ground) had decreased among PWID utilizing the SIF.
Methods
Between February and
August of 2013, we conducted interviews using a survey (in English and Danish)
with forty-one people who reported injecting drugs at the SIF. We used
descriptive statistics and McNemar’s test to examine sociodemographic
characteristics of the sample, current drugs used, sites of syringe disposal
before and after opening of the SIF, and perceived behavior change since using
the SIF.
Results
Of the interviewed
participants, 90.2% were male and the majority were younger than 40 years
old (60.9%). Three-quarters (75.6%) of participants reported reductions in
injection risk behaviors since the opening of the SIF, such as injecting in a
less rushed manner (63.4%), fewer outdoor injections (56.1%), no longer syringe
sharing (53.7%), and cleaning injecting site(s) more often (43.9%).
Approximately two-thirds (65.9%) of participants did not feel that their
frequency of injecting had changed; five participants (12.2%) reported a
decrease in injecting frequency, and only two participants (4.9%) reported an
increase in injecting frequency. Twenty-four (58.5%) individuals reported
changing their syringe disposal practices since the opening of the SIF; of
those, twenty-three (95.8%) reported changing from not always disposing safely
to always disposing safely (McNemar’s test p-value < 0.001).
Conclusions
Our findings suggest
that use of the Copenhagen SIF is associated with adoption of safer behaviors
that reduce harm and promote health among PWID, as well as practices that
benefit the Vesterbro neighborhood (i.e., safer syringe disposal). As a public
health intervention, Copenhagen’s SIF has successfully reached PWID engaging in
risk behavior. To fully characterize the impacts of this and other Danish SIFs,
further research should replicate this study with a larger sample size and
prospective follow-up.
Table 2
Primary locations for disposal of used syringes among a sample of people who inject drugs before and after the opening of a supervised injecting facility in Copenhagen, Denmark ( n = 41)
| Disposal mechanism/site | Before SIF opened n (%) | After SIF opened n (%) |
|---|---|---|
| Returned to the needle exchange (or SIF) | 14 (34.1) | 36 (87.8) |
| Put them in an outdoors sharps container | 19 (46.3) | 8 (19.5) |
| Put them in their own sharps container | 11 (26.8) | 6 (14.6) |
| Threw them in the garbage | 23 (56.1) | 5 (12.2) |
| Dropped them on the ground | 5 (12.2) | 0 (0.0) |
| Gave them to another user | 2 (4.9) | 0 (0.0) |
| Flushed them down the toilet | 4 (9.8) | 0 (0.0) |
| Other | 3 (7.3) | 0 (0.0) |
Note: n’s do not sum to 41 and proportions do not sum to 100% because participants may have identified more than one location as primary site of used syringe disposal.
Note: all data collected between February and August, 2013.
Table 3
Perceived behavior and frequency change among a sample of people who inject drugs at a supervised injecting facility since its opening in Copenhagen, Denmark ( n = 41)
| Characteristic | n (%) |
|---|---|
| Any perceived behavior change | 31 (75.6) |
| Less rushed/stressful | 26 (63.4) |
| Less injecting outdoors | 23 (56.1) |
| No longer share needles | 22 (53.7) |
| Clean injection site more often | 18 (43.9) |
| Easier to get vein first time | 16 (39.0) |
| Reuse own needles less often | 11 (26.8) |
| Use clean water more often | 11 (26.8) |
| No longer need help injecting | 6 (14.6) |
| Other | 3 (7.3) |
| Perceived frequency change | |
| No change | 27 (65.9) |
| Decreased (inject less often) | 5 (12.2) |
| Increased (inject more often) | 2 (4.9) |
| Unsure | 4 (9.8) |
Note: n’s do not sum to 41 and proportions do not sum to 100% due to missing values or where participants endorsed more than one option.
Note: all data collected between February and August, 2013.
Full article at: http://goo.gl/2IuC7S
By: 
Chanelle J Howe, Thomas Kerr, Vibeke Skjødt Hass, and Brandon DL Marshall
Chanelle J Howe, Thomas Kerr, Vibeke Skjødt Hass, and Brandon DL Marshall
Department of
Behavioral and Social Sciences, Brown University School of Public Health, 121
South Main Street, Box G-S-121-4 Providence, RI 02912 USA
Department of
Epidemiology, Brown University School of Public Health, 121 South Main Street,
Box G-S-121-2, Providence, RI 02912 USA
Faculty of
Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall,
Vancouver, BC V6T 1Z3 Canada
Urban Health
Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, 608 –
1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
The Saxo
Institute, Faculty of Humanities, University of Copenhagen, Karen Blixens Vej
4, DK-2300 Copenhagen, Denmark
Elizabeth N Kinnard, Email: ude.nworb@dranniK_htebazilE.
More at: https://twitter.com/hiv_insight
Willingness to Access an In-Hospital Supervised Injection Facility among Hospitalized People Who Use Illicit Drugs
BACKGROUND:
OBJECTIVE:
DESIGN:
SETTING:
MEASUREMENTS:
RESULTS:
CONCLUSIONS:
Purchase full article at: http://goo.gl/86AYux
By:
- 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
More at: https://twitter.com/hiv_insight
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