Abstract
BackgroundInjection drug use is associated with HIV and hepatitis C transmission, overdose, and other preventable harms. These harms are heightened for structurally vulnerable injection drug-using populations, as their social conditions pose barriers to safer injecting. Previous research on injection cessation has largely focused on adult drug-using populations. Little qualitative work has examined the social, structural, and environmental factors that shape periods of injection cessation among youth and young adults. Such research is essential to understanding how we can best reduce harms among this vulnerable population as they move in and out of periods of injection cessation.MethodsWe conducted 22 semi-structured, qualitative interviews with street-involved young people who use drugs (SY), focused on characterizing their transitions into periods of injection cessation and perceived barriers to injection cessation. Adopting an ethno-epidemiological approach, participants who had experienced at least 6 months of injection cessation were purposively recruited from an ongoing prospective cohort study of SY in Vancouver, Canada to participate in qualitative interviews. Qualitative interview findings were triangulated with the findings of a longitudinal program of ethnographic research with SY in this setting. This ethno-epidemiological approach allowed for a more robust exploration of contextual factors surrounding drug use patterns than would be possible through traditional epidemiological methods alone.ResultsFindings indicate that periods of injection cessation were influenced by access to harm reduction-informed youth-focused services, transitions in route of administration (e.g., from injecting methamphetamine to the smoking of methamphetamine), and the provision of housing and social supports (e.g., from friends, family, and care providers). Conversely, participants indicated that inadequate social supports and, for some, abstinence-focused treatment methods (e.g., 12-step programs), impeded efforts to cease injecting.ConclusionsTo reduce harms, it is imperative to reorient attention toward the social, structural, and spatial contexts that surround injection drug use and shape periods of injection cessation for SY. There is an urgent need for more comprehensive youth-focused services for those engaged in injection drug use, and further study of innovative means of engaging youth.
Highlights
Injection drug use is associated with Human immunodeficiency virus (HIV) and hepatitis C transmission, overdose, and other preventable harms
Injection drug use is associated with the transmission of blood-borne viruses such as HIV and hepatitis C (HCV), fatal and non-fatal overdose, and other preventable harms [1,2,3,4]
Whether Street-involved young people who use drugs (SY) worked to slowly reduce injection drug use or quit all at once, for many young people periods of injection cessation were accomplished independent of engagement with addiction services, via a transition to a new route of administration and/or a new drug
Summary
Injection drug use is associated with HIV and hepatitis C transmission, overdose, and other preventable harms These harms are heightened for structurally vulnerable injection drug-using populations, as their social conditions pose barriers to safer injecting. Injection drug use is associated with the transmission of blood-borne viruses such as HIV (human immunodeficiency virus) and hepatitis C (HCV), fatal and non-fatal overdose, and other preventable harms [1,2,3,4]. It is recognized, that many of the risks and harms accompanying injection drug use do not come from the actual act of injecting. Route transitions can serve to reduce the health risks associated with injection drug use such as overdose, vein damage, bacterial infection, and blood-borne virus transmission [9,10,11,12]
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