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Patterns of Non-injection Drug Use Associated with Injection Cessation among Street-Involved Youth in Vancouver, Canada

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Abstract

Although abstinence from drug use is often a key goal of youth substance use treatment, transitioning to less harmful routes and types of drug use is desirable from both a clinical and public health perspective. Despite this, little is known about the trajectories of youth who inject drugs including changes in patterns of non-injection drug use. The At-Risk Youth Study (ARYS) is a longitudinal cohort of street-involved youth who use drugs in Vancouver, Canada. We used linear growth curve modeling to compare changes in non-injection drug use among participants who ceased injecting drugs for at least one 6-month period between September 2005 and May 2015 to matched controls who continued injecting over the same period. Of 387 eligible participants, 173 (44.7%) reported ceasing drug injection at least once. Non-injection drug use occurred during 160 (79.6%) periods of injection cessation. In adjusted linear growth curve analyses, the only non-injection drug use pattern observed to decrease significantly more than controls following injection cessation was daily crack/cocaine use (p = 0.024). With the exception of frequent crack/cocaine use, transitions out of injection drug use did not appear to coincide with increased reductions in patterns of non-injection drug use. Our findings indicate that most (80%) of the observed injection cessation events occurred in the context of ongoing substance use. Given that transitioning out of drug injection represents a significant reduction in risk and harm, efforts supporting vulnerable youth to move away from injecting may benefit from approaches that allow for ongoing non-injection drug use.

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Acknowledgments

We extend our gratitude to the participants of the At-Risk Youth Study for their contribution to the research. We would also like to thank past and present study staff including Cody Callon, Sabina Dobrer, Deborah Graham, Peter Vann, Steve Kain, and Tricia Collingham for their administrative support.

Funding

This study was supported by the United States National Institutes of Health (U01DA038886). Stephanie Lake is supported through doctoral awards from the Canadian Institutes of Health Research (CIHR) and the Pierre Elliott Trudeau Foundation (2017). Dr. Kora DeBeck is supported by a Michael Smith Foundation for Health Research/St. Paul’s Hospital Foundation-Providence Health Care Career Scholar Award and a CIHR New Investigator Award. Dr. Evan Wood receives support through a Tier 1 Canada Research Chair in Inner City Medicine. Dr. Kerr is supported by a foundation grant from the Canadian Institutes of Health Research (20R74326). Dr. Milloy is supported in part by the United States National Institutes on Health (R01-DA0251525), a New Investigator award from CIHR and a Scholar Award from the Michael Smith Foundation for Health Research. His institution has received an unstructured gift to support his research from NG Biomed, Ltd., an applicant to the Canadian federal government for a license to produce medical cannabis. Funding sources had no role in the design of this study; collection, analysis, and interpretation of the data; writing of the report; or the decision to submit the paper for publication.

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Authors and Affiliations

  1. BC Centre on Substance Use, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Stephanie Lake, Thomas Kerr, Ekaterina Nosova, M-J Milloy, Evan Wood & Kora DeBeck

  2. School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada

    Stephanie Lake

  3. Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Thomas Kerr, M-J Milloy & Evan Wood

  4. School of Public Policy, Simon Fraser University, Suite 3271 – 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada

    Kora DeBeck

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  1. Stephanie Lake
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  2. Thomas Kerr
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  3. Ekaterina Nosova
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  4. M-J Milloy
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Correspondence to Kora DeBeck.

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Lake, S., Kerr, T., Nosova, E. et al. Patterns of Non-injection Drug Use Associated with Injection Cessation among Street-Involved Youth in Vancouver, Canada. J Urban Health 95, 267–277 (2018). https://doi.org/10.1007/s11524-017-0225-3

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