Injection drug use among street-involved youth in a Canadian setting

Thomas Kerr,Evan Wood,Cari Miller,Ruth Zhang,Julio Sg Montaner,Brandon Dl Marshall,Kate Shannon

doi:10.1186/1471-2458-9-171

Abstract

BackgroundStreet-involved youth contend with an array of health and social challenges, including elevated rates of blood-borne infections and mortality. In addition, there has been growing concern regarding high-risk drug use among street-involved youth, in particular injection drug use. We undertook this study to examine the prevalence of injection drug use and associated risks among street-involved youth in Vancouver, Canada.MethodsFrom September 2005 to November 2007, baseline data were collected for the At-Risk Youth Study (ARYS), a prospective cohort of street-recruited youth aged 14 to 26 in Vancouver, Canada. Using multiple logistic regression, we compared youth with and without a history of injection.ResultsThe sample included 560 youth among whom the median age was 21.9 years, 179 (32%) were female, and 230 (41.1%) reported prior injection drug use. Factors associated with injection drug use in multivariate analyses included age ≥ 22 years (adjusted odds ratio [AOR] = 1.18, 95% CI: 1.10–1.28); sex work involvement (AOR = 2.17, 95% CI: 1.35–3.50); non-fatal overdose (AOR = 2.10, 95% CI: 1.38–3.20); and hepatitis C (HCV) infection (AOR = 22.61, 95% CI: 7.78–65.70).ConclusionThese findings highlight an alarmingly high prevalence of injection drug use among street-involved youth and demonstrate its association with an array of risks and harms, including sex work involvement, overdose, and HCV infection. These findings point to the need for a broad set of policies and interventions to prevent the initiation of injection drug use and address the risks faced by street-involved youth who are actively injecting.

Highlights

Street-involved youth contend with an array of health and social challenges, including elevated rates of blood-borne infections and mortality
Factors associated with injection drug use in univariate analyses are presented in Table 1 and include: age ≥ 22 year; history of incarceration (OR = 2.04, 95% Confidence Interval (95% CI): 1.31–3.18, p < 0.001); sex work involvement (OR = 2.86, 95% CI: 1.89–4.32, p < 0.001); drug dealing (OR = 1.61, 95% CI: 1.10–2.42, p = 0.023); having a warrant for one's arrest (OR = 1.56, 95% CI: 1.03–2.33, p = 0.037); non-fatal overdose (OR = 2.76, 95% CI: 1.92–3.97, p < 0.001); and HCV infection (OR = 29.51, 95% CI: 10.55–82.53, p < 0.001)
In a multivariate analysis, reporting a history of injection drug use was associated with older age, sex work involvement, non-fatal overdose, and hepatitis C infection

Summary

Introduction

Street-involved youth contend with an array of health and social challenges, including elevated rates of blood-borne infections and mortality. We undertook this study to examine the prevalence of injection drug use and associated risks among street-involved youth in Vancouver, Canada. Compared to the general population, street-involved youth contend with a variety of health-related risks and challenges [1], including elevated rates of mental illness [5], blood-borne infections [5,6,7], sexually transmitted infections [8], and violence [9,10]. In light of the associated risks for human immunodeficiency virus (HIV) and hepatitis C infection (HCV), increasing attention has been paid to the initiation of injection drug use within this population. There remain many challenges associated with estimating the size of this population given the transitory nature of street youth and lack of reliable counts of street youth (e.g., Census data, etc)

Methods

Results

Discussion

Conclusion