Potential use of supervised injection services among people who inject drugs in a remote and mid-size Canadian setting

Sanjana Mitra,Cynthia Olsen,Zack Marshall,Thomas Kerr,Sean Rourke,Beth Rachlis,Bonnie Krysowaty

doi:10.1186/s12889-019-6606-7

Abstract

BackgroundWhile supervised injection services (SIS) feasibility research has been conducted in large urban centres across North America, it is unknown whether these services are acceptable among people who inject drugs (PWID) in remote, mid-size cities. We assessed willingness to use SIS and expected frequency of SIS use among PWID in Thunder Bay, a community in Northwestern, Ontario, Canada, serving people from suburban, rural and remote areas of the region.MethodsBetween June and October 2016, peer research associates administered surveys to PWID. Sociodemographic characteristics, drug use and behavioural patterns associated with willingness to use SIS and expected frequency of SIS use were estimated using bivariable and multivariable logistic regression models. Design preferences and amenities identified as important to provide alongside SIS were assessed descriptively.ResultsAmong 200 PWID (median age, IQR: 35, 28–43; 43% female), 137 (69%) reported willingness to use SIS. In multivariable analyses, public injecting was positively associated with willingness to use (Adjusted Odds Ratio (AOR): 4.15; 95% confidence interval (CI): 2.08–8.29). Among those willing to use SIS, 87 (64%) said they would always/usually use SIS, while 48 (36%) said they would sometime/occasionally use SIS. In multivariable analyses, being female (AOR: 2.44; 95% CI: 1.06–5.65) and reporting injecting alone was positively associated with higher expected frequency of use (AOR: 2.59; 95% CI: 1.02–6.58).ConclusionsOur findings suggest that SIS could play a role in addressing the harms of injection drug use in remote and mid-sized settings particularly for those who inject in public, as well as women and those who inject alone, who report higher expected frequency of SIS use. Design preferences of local PWID, in addition to differences according to gender should be taken into consideration to maximize the uptake of SIS, alongside existing health and social service provisions available to PWID.

Highlights

While supervised injection services (SIS) feasibility research has been conducted in large urban centres across North America, it is unknown whether these services are acceptable among people who inject drugs (PWID) in remote, mid-size cities
Cities across North America are contending with epidemics of opioid use and fatal drug poisoning linked to injection drug use, as well as other associated harms such as soft tissue infections, endocarditis and blood-borne infections [1,2,3,4]
Beyond the individual-level health-related harms experienced by people who inject drugs (PWID), injection drug use in public spaces is perceived as a major community concern, contributing to the improper disposal of syringes and other injection-related materials [5]

Summary

Introduction

While supervised injection services (SIS) feasibility research has been conducted in large urban centres across North America, it is unknown whether these services are acceptable among people who inject drugs (PWID) in remote, mid-size cities. Cities across North America are contending with epidemics of opioid use and fatal drug poisoning linked to injection drug use, as well as other associated harms such as soft tissue infections, endocarditis and blood-borne infections [1,2,3,4]. Beyond the individual-level health-related harms experienced by people who inject drugs (PWID), injection drug use in public spaces is perceived as a major community concern, contributing to the improper disposal of syringes and other injection-related materials [5]. In Canada, two long-standing SIS have been operating in Vancouver for over a decade [11, 12], with new sites opening in urban centres across British Columbia, Ontario, Alberta and Quebec in the past year [13, 14]

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