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:   Scott E. Hadland, MD, MPH,1,2 Kora DeBeck, PhD,3,4 Thomas Kerr, PhD,3,5 Paul Nguyen, PhD,3 Annick Simo, MSc,3Julio S. Montaner, MD,3,5 and Evan Wood, MD, PhD3,5

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

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