Nurse-delivered safer injection education among a cohort of injection drug users: Evidence from the evaluation of Vancouver's supervised injection facility

Abstract

Background Despite growing implementation of harm reduction programs internationally, unsafe injecting practices remain common among injection drug users (IDU). In response, nursing interventions such as safer injection education (SIE) have been called for. In Vancouver, a supervised injection facility (SIF), where IDU inject pre-obtained illicit drugs under nursing supervision, opened in 2003 in an effort to reduce the impacts of unsafe injecting. We sought to characterize the state of nursing SIE practice in Vancouver and prospectively examine SIE among SIF users. Methods We examined correlates of receiving SIE among participants in the Scientific Evaluation of Supervised Injecting (SEOSI) cohort. The SEOSI cohort was derived through random recruitment of SIF users. Characteristics of participants who reported receiving SIE from SIF nurses were examined using bivariate and multivariate generalized estimating equations. Results 1087 SEOSI participants were surveyed between March 2004 and March 2005 and included in this analysis. Approximately one third of participants reported receiving SIE at baseline and an additional 13.3% reported receiving SIE during follow-up. Those receiving SIE from SIF nurses were more likely to be females (AOR = 1.55; 95% CI: 1.18–2.04), persons requiring injecting assistance (AOR = 1.52; 95% CI: 1.26–1.84), binge users (AOR = 1.37; 95% CI: 1.14–1.64), and those using the SIF for most of their injections (AOR = 1.47; 95% CI: 1.22–1.77). Conclusions These findings provide evidence to support the need for nurse-delivered SIE in reaching IDU most at risk for injection-related harm. SIFs may afford unique opportunities to deliver SIE to high-risk populations. Individuals receiving SIE from Vancouver's SIF nurses were likely to possess characteristics associated with adverse health outcomes, including HIV infection.