Abstract
BackgroundPreventing injection drug use among vulnerable youth is critical for reducing serious drug-related harms. Addiction treatment is one evidence-based intervention to decrease problematic substance use; however, youth frequently report being unable to access treatment services and the impact of this on drug use trajectories remains largely unexplored. This study examines the relationship between being unable to access addiction treatment and injection initiation among street-involved youth.MethodsData were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth aged 14–26 who use illicit drugs, from September 2005 to May 2014. An extended Cox model with time-dependent variables was used to identify factors independently associated with injection initiation.ResultsAmong 462 participants who were injection naïve at baseline, 97 (21 %) initiated injection drug use over study follow-up and 129 (28 %) reported trying but being unable to access addiction treatment in the previous 6 months at some point during the study period. The most frequently reported reason for being unable to access treatment was being put on a wait list. In a multivariable Cox regression analysis, being unable to access addiction treatment remained independently associated with a more rapid rate of injection initiation (Adjusted Hazard Ratio =2.02; 95 % Confidence Interval: 1.12–3.62), after adjusting for potential confounders.ConclusionInability to access addiction treatment was common among our sample and associated with injection initiation. Findings highlight the need for easily accessible, evidence-based addiction treatment for high-risk youth as a means to prevent injection initiation and subsequent serious drug-related harms.
Highlights
Preventing injection drug use among vulnerable youth is critical for reducing serious drug-related harms
* Correspondence: urhi-kd@cfenet.ubc.ca 1British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada 2School of Public Policy, Simon Fraser University, Vancouver, Canada Full list of author information is available at the end of the article use practices that put them at higher risk of drug overdose and infectious disease transmission [3, 4, 7,8,9]. Structural level influences, such as homelessness and unemployment [10,11,12], alongside individual level factors including childhood trauma, and specific drug use patterns [13, 14], have been recognized as factors that facilitate transitions into injection drug use among vulnerable youth. While these findings suggest that injection prevention efforts should be directed to the areas of housing, employment, and childhood trauma prevention and recovery, addiction treatment may provide additional opportunities to reduce injection initiation
To determine the role that barriers to accessing addiction treatment may play in influencing drug use trajectories, we examined whether inability to access addiction treatment was associated with injection initiation among a cohort of streetinvolved youth
Summary
Data for this study was obtained from the At-Risk Youth Study (ARYS), which is an open prospective cohort of street-involved youth in Vancouver, Canada that has been described in detail previously [21]. To examine the potential relationship between initiation into injection drug use and inability to access addiction treatment, all participants who had never injected drugs at baseline and had completed at least one follow-up visit during the study period were included in the present analysis. For descriptive purposes we assessed the median number of years between initiation of non-injection “hard” drug use (defined as use of heroin, cocaine, crack, or crystal methamphetamine) and initiation of injection drug use These estimates were based on the reported age of first non-injection “hard” drug use, and age of participants at the midpoint between the last report of remaining injection naïve and the first report of having used a needle to chip, fix, or muscle drugs.
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