Advertisement

Journal of Urban Health

, Volume 95, Issue 1, pp 83–90 | Cite as

Non-injection Drug Use and Injection Initiation Assistance among People Who Inject Drugs in Tijuana, Mexico

  • Amen Ben Hamida
  • Claudia Rafful
  • Sonia Jain
  • Shelly Sun
  • Patricia Gonzalez-Zuniga
  • Gudelia Rangel
  • Steffanie A. Strathdee
  • Dan Werb
Article

Abstract

Although most people who inject drugs (PWID) report receiving assistance during injection initiation events, little research has focused on risk factors among PWID for providing injection initiation assistance. We therefore sought to determine the influence of non-injection drug use among PWID on their risk to initiate others. We used generalized estimating equation (GEE) models on longitudinal data among a prospective cohort of PWID in Tijuana, Mexico (Proyecto El Cuete IV), while controlling for potential confounders. At baseline, 534 participants provided data on injection initiation assistance. Overall, 14% reported ever initiating others, with 4% reporting this behavior recently (i.e., in the past 6 months). In a multivariable GEE model, recent non-injection drug use was independently associated with providing injection initiation assistance (adjusted odds ratio [AOR] = 2.42, 95% confidence interval [CI] = 1.39–4.20). Further, in subanalyses examining specific drug types, recent non-injection use of cocaine (AOR = 9.31, 95% CI = 3.98–21.78), heroin (AOR = 4.00, 95% CI = 1.88–8.54), and methamphetamine (AOR = 2.03, 95% CI = 1.16–3.55) were all significantly associated with reporting providing injection initiation assistance. Our findings may have important implications for the development of interventional approaches to reduce injection initiation and related harms. Further research is needed to validate findings and inform future approaches to preventing entry into drug injecting.

Keywords

Injection initiation Injection drug use People who inject drugs Non-injection drug use Tijuana Border health Prevention 

Notes

Acknowledgements

Dan Werb is supported by a grant to the PRIMER study from the National Institute on Drug Abuse (NIDA DP2-DA040256-01) and by the Canadian Institutes of Health Research via a New Investigator Award. El Cuete IV is also supported by NIDA via a MERIT Award (R37 DA019829). C. Rafful was supported by a UC-MEXUS/CONACyT scholarship grant number 209407/313533, the UC MEXUS Dissertation grant number DI 15-42, and R25 DA026401.

References

  1. 1.
    UNODC. World Drug Report. May, 2016. 2016; http://www.unodc.org/wdr2016/. Accessed April 10, 2017
  2. 2.
    UNAIDS. Prevention gap report. July 11, 2016; http://www.unaids.org/en/resources/documents/2016/prevention-gap. Accessed April 10, 2017.
  3. 3.
    Ly KN, Xing J, Klevens RM, Jiles RB, Ward JW, Holmberg SD. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med. 2012;156(4):271–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Mehta SH, McFall AM, Srikrishnan AK, et al. Morbidity and mortality among community-based people who inject drugs with a high hepatitis C and human immunodeficiency virus burden in Chennai, India. Open Forum Infect Dis . 2016;3(3):ofw121.Google Scholar
  5. 5.
    Lumbreras B, Jarrin I, del Amo J, et al. Impact of hepatitis C infection on long-term mortality of injecting drug users from 1990 to 2002: differences before and after HAART. AIDS. 2006;20(1):111–6.Google Scholar
  6. 6.
    Rockstroh JK. Influence of viral hepatitis on HIV infection. J Hepatol. 2006;44(1 Suppl):S25–7.Google Scholar
  7. 7.
    Lloyd-Smith E, Wood E, Zhang R, Tyndall MW, Montaner JS, Kerr T. Risk factors for developing a cutaneous injection-related infection among injection drug users: a cohort study. BMC Public Health. 2008;8:405.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Millar B, Moore J. Emerging issues in infective endocarditis. Emerg Infect Dis J 2004;Volume 10.Google Scholar
  9. 9.
    Milloy MJ, Kerr T, Tyndall M, Montaner J, Wood E. Estimated drug overdose deaths averted by North America’s first medically-supervised safer injection facility. PLoS One. 2008;3(10):e3351.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Vlahov D, Fuller CM, Ompad DC, Galea S, Des Jarlais DC. Updating the infection risk reduction hierarchy: preventing transition into injection. J Urban Health. 2004;81(1):14–9.Google Scholar
  11. 11.
    Werb D, Garfein R, Kerr T, et al. A socio-structural approach to preventing injection drug use initiation: rationale for the PRIMER study. Harm Reduct J. 2016;13(1):25.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Bluthenthal RN, Kral AH. Next steps in research on injection initiation incidence and prevention. Addiction. 2015;110(8):1258–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Debeck K, Kerr T, Marshall BD, Simo A, Montaner J, Wood E. Risk factors for progression to regular injection drug use among street-involved youth in a Canadian setting. Drug Alcohol Depend. 2013;133(2):468–72.CrossRefPubMedGoogle Scholar
  14. 14.
    van Ameijden EJ, van den Hoek JA, Hartgers C, Coutinho RA. Risk factors for the transition from noninjection to injection drug use and accompanying AIDS risk behavior in a cohort of drug users. Am J Epidemiol. 1994;139(12):1153–63.CrossRefPubMedGoogle Scholar
  15. 15.
    Garfein RS, Vlahov D, Galai N, Doherty MC, Nelson KE. Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses. Am J Public Health. 1996;86(5):655–61.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Carneiro M, Fuller C, Doherty MC, Vlahov D. HIV prevalence and risk behaviors among new initiates into injection drug use over the age of 40 years old. Drug Alcohol Depend. 1999;54(1):83–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Kral AH, Lorvick J, Edlin BR. Sex- and drug-related risk among populations of younger and older injection drug users in adjacent neighborhoods in San Francisco. J Acquir Immune Defic Syndr. 2000;24(2):162–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Doherty MC, Garfein RS, Monterroso E, Brown D, Vlahov D. Correlates of HIV infection among young adult short-term injection drug users. AIDS. 2000;14(6):717–26.CrossRefPubMedGoogle Scholar
  19. 19.
    Strike C, Rotondi M, Kolla G, et al. Interrupting the social processes linked with initiation of injection drug use: results from a pilot study. Drug Alcohol Depend. 2014;137:48–54.CrossRefPubMedGoogle Scholar
  20. 20.
    Brouwer KC, Case P, Ramos R, et al. Trends in production, trafficking, and consumption of methamphetamine and cocaine in Mexico. Subst Use Misuse. 2006;41(5):707–27.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Magis-Rodriguez C, Brouwer KC, Morales S, et al. HIV prevalence and correlates of receptive needle sharing among injection drug users in the Mexican-U.S. border city of Tijuana. J Psychoactive Drugs. 2005;37(3):333–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Strathdee SA, Lozada R, Pollini RA, et al. Individual, social, and environmental influences associated with HIV infection among injection drug users in Tijuana. Mexico J Acquir Immune Defic Syndr. 2008;47(3):369–76.Google Scholar
  23. 23.
    Strathdee SA, Magis-Rodriguez C. Mexico’s evolving HIV epidemic. JAMA. 2008;300(5):571–3.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Werb D, Buxton J, Shoveller J, Richardson C, Rowell G, Wood E. Interventions to prevent the initiation of injection drug use: a systematic review. Drug Alcohol Depend. 2013;133(2):669–76.CrossRefPubMedGoogle Scholar
  25. 25.
    Bryant J, Treloar C. The gendered context of initiation to injecting drug use: evidence for women as active initiates. Drug Alcohol Rev. 2007;26(3):287–93.CrossRefPubMedGoogle Scholar
  26. 26.
    Crofts N, Louie R, Rosenthal D, Jolley D. The first hit: circumstances surrounding initiation into injecting. Addiction. 1996;91(8):1187–96.CrossRefPubMedGoogle Scholar
  27. 27.
    Doherty MC, Garfein RS, Monterroso E, Latkin C, Vlahov D. Gender differences in the initiation of injection drug use among young adults. J Urban Health. 2000;77(3):396–414.Google Scholar
  28. 28.
    Goldsamt LA, Harocopos A, Kobrak P, Jost JJ, Clatts MC. Circumstances, pedagogy and rationales for injection initiation among new drug injectors. J Community Health. 2010;35(3):258–67.Google Scholar
  29. 29.
    Harocopos A, Goldsamt LA, Kobrak P, Jost JJ, Clatts MC. New injectors and the social context of injection initiation. Int J Drug Policy. 2009;20(4):317–23.Google Scholar
  30. 30.
    Rahimi-Movaghar A, Amin-Esmaeili M, Shadloo B, Noroozi A, Malekinejad M. Transition to injecting drug use in Iran: a systematic review of qualitative and quantitative evidence. Int J Drug Pol. 2015;26(9):808–19.Google Scholar
  31. 31.
    Roy E, Haley N, Leclerc P, Cedras L, Blais L, Boivin JF. Drug injection among street youths in Montreal: predictors of initiation. J Urban Health. 2003;80(1):92–105.Google Scholar
  32. 32.
    Rotondi NK, Strike C, Kolla G, et al. Transition to injection drug use: the role of initiators. AIDS Behav. 2014;18(3):486–94.CrossRefPubMedGoogle Scholar
  33. 33.
    Kermode M, Longleng V, Singh BC, Hocking J, Langkham B, Crofts N. My first time: initiation into injecting drug use in Manipur and Nagaland, north-east India. Harm Reduct J. 2007;4:19.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Bluthenthal RN, Wenger L, Chu D, Quinn B, Thing J, Kral AH. Factors associated with initiating someone into illicit drug injection. Drug Alcohol Depend. 2014;144:186–92.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Bryant J, Treloar C. Initiators: an examination of young injecting drug users who initiate others to injecting. AIDS Behav. 2008;12(6):885–90.CrossRefPubMedGoogle Scholar
  36. 36.
    Werb D, Kerr T, Buxton J, et al. Crystal methamphetamine and initiation of injection drug use among street-involved youth in a Canadian setting. CMAJ. 2013;185(18):1569–75.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Young AM, Havens JR. Transition from first illicit drug use to first injection drug use among rural Appalachian drug users: a cross-sectional comparison and retrospective survival analysis. Addiction. 2012;107(3):587–96.CrossRefPubMedGoogle Scholar
  38. 38.
    DeBeck K, Wood E, Dong H, et al. Non-medical prescription opioid use predicts injection initiation among street-involved youth. Int J Drug Policy. 2016;34:96–100.Google Scholar
  39. 39.
    Werb D, Garfein RS, Kerr T, et al. A socio-structural approach to preventing injection drug use initiation: rationale for the PRIMER study. Harm Reduct J. 2016;13(1):25.Google Scholar
  40. 40.
    Zeger SL, Liang K-Y. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42(1):121–30.CrossRefPubMedGoogle Scholar
  41. 41.
    Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. Lancet. 2005;366(9482):316–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Wood E, Tyndall MW, Montaner JS, Kerr T. Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. CMAJ. 2006;175(11):1399–404.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Marshall BD, Milloy MJ, Wood E, Montaner JS, Kerr T. Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. Lancet. 2011;377(9775):1429–37.CrossRefPubMedGoogle Scholar
  44. 44.
    Kimber J, Dolan K, van Beek I, Hedrich D, Zurhold H. Drug consumption facilities: an update since 2000. Drug Alcohol Rev. 2003;22(2):227–33.CrossRefPubMedGoogle Scholar
  45. 45.
    Lloyd C, Hunt N. Drug consumption rooms: an overdue extension to harm reduction policy in the UK? Int J Drug Policy. 2007;18(1):5–9.Google Scholar
  46. 46.
    Small W, Fast D, Krusi A, Wood E, Kerr T. Social influences upon injection initiation among street-involved youth in Vancouver Canada: a qualitative study. Subst Abuse Treat Prev Policy. 2009;4:8.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Rivera AV, DeCuir J, Crawford ND, Amesty S, Lewis CF. Internalized stigma and sterile syringe use among people who inject drugs in New York City, 2010-2012. Drug Alcohol Depend. 2014;144:259–64.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Meacham MC, Roesch SC, Strathdee SA, Lindsay S, Gonzalez-Zuniga P, Gaines TL. Latent classes of polydrug and polyroute use and associations with human immunodeficiency virus risk behaviours and overdose among people who inject drugs in Tijuana, Baja California, Mexico. Drug Alcohol Rev . 2017.Google Scholar
  49. 49.
    Neaigus A, Gyarmathy VA, Miller M, Frajzyngier VM, Friedman SR, Jarlais DCD. Transitions to injecting drug use among noninjecting heroin users. Jaids J Acquir Immune Defic Syndr. 2006;41(4):493–503.Google Scholar
  50. 50.
    Buster MCA, Witteveen E, Prins M, van Ameijden EJC, Schippers G, Krol A. Transitions in drug use in a new generation of problem drug users in Amsterdam: a 6-year follow-up study. Eur Addict Res. 2009;15(4):179–87.CrossRefPubMedGoogle Scholar
  51. 51.
    Strathdee SA, Fraga WD, Case P, et al. “Vivo para consumirla y la consumo para vivir” [“I live to inject and inject to live”]: high-risk injection behaviors in Tijuana, Mexico. J Urban Health . 2005;82(3 Suppl 4):iv58–73.Google Scholar
  52. 52.
    Pollini RA, Brouwer KC, Lozada RM, et al. Syringe possession arrests are associated with receptive syringe sharing in two Mexico-US border cities. Addiction. 2008;103(1):101–8.CrossRefPubMedGoogle Scholar
  53. 53.
    Miller CL, Firestone M, Ramos R, et al. Injecting drug users’ experiences of policing practices in two Mexican-U.S. border cities: public health perspectives. Int J Drug Policy. 2008;19(4):324–31.Google Scholar
  54. 54.
    Werb D, Strathdee SA, Vera A, et al. Spatial patterns of arrests, police assault and addiction treatment center locations in Tijuana, Mexico. Addiction. n111(7):1246–56.Google Scholar
  55. 55.
    Guerrero J. Tijuana mandates drug treatment for hundreds of homeless. KPBS April 13, 2015. http://www.kpbs.org/news/2015/apr/13/tijuana-homeless-get-compulsory-treatment/. Accessed April 10, 2017.

Copyright information

© The New York Academy of Medicine 2017

Authors and Affiliations

  • Amen Ben Hamida
    • 1
    • 2
  • Claudia Rafful
    • 1
    • 2
  • Sonia Jain
    • 3
  • Shelly Sun
    • 3
  • Patricia Gonzalez-Zuniga
    • 1
  • Gudelia Rangel
    • 4
    • 5
  • Steffanie A. Strathdee
    • 1
  • Dan Werb
    • 1
    • 6
    • 7
  1. 1.Division of Global Public HealthUniversity of California San DiegoSan DiegoUSA
  2. 2.Graduate School of Public HealthSan Diego State UniversitySan DiegoUSA
  3. 3.Department of Family Medicine and Public Health, Biostatistics Research CenterUniversity of California San DiegoSan DiegoUSA
  4. 4.Secretariat of HealthMexico CityMexico
  5. 5.Mexico-United States Border Health CommissionEl PasoUSA
  6. 6.Centre for Urban Health Solutions, St. Michael’s HospitalTorontoCanada
  7. 7.University of California School of MedicineLa JollaUSA

Personalised recommendations