UBC Faculty Research and Publications

Income Generating Activities of People Who Inject Drugs DeBeck, Kora; Shannon, Kate; Wood, Evan; Li, Kathy; Montaner, Julio; Kerr, Thomas Nov 2, 2007

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata


52383-DeBeck_K_et_al_Income_generating_activities.pdf [ 78.68kB ]
JSON: 52383-1.0339966.json
JSON-LD: 52383-1.0339966-ld.json
RDF/XML (Pretty): 52383-1.0339966-rdf.xml
RDF/JSON: 52383-1.0339966-rdf.json
Turtle: 52383-1.0339966-turtle.txt
N-Triples: 52383-1.0339966-rdf-ntriples.txt
Original Record: 52383-1.0339966-source.json
Full Text

Full Text

Income Generating Activities of People Who Inject DrugsKora DeBeck1, Kate Shannon1, Evan Wood1,2, Kathy Li1, Julio Montaner1,2, and ThomasKerr1,21 British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, St Paul's Hospital,Vancouver, British Columbia, V6Z 1Y6 Canada2 Department of Medicine, University of British Columbia, Vancouver, British Columbia, V6Z1Y6 CanadaAbstractBackground—Injection drug users (IDU) commonly generate income through prohibitedactivities, such as drug dealing and sex trade work, which carry significant risk. However, little isknown about the IDU who engage in such activities and the role of active drug use in perpetuatingthis behavior.Methods—We evaluated factors associated with prohibited income generation among participantsenrolled in the Vancouver Injection Drug Users Study (VIDUS) using logistic and linear regression.We also examined which sources of income respondents would eliminate if they did not requiremoney to pay for drugs.Results—Among 275 IDU, 145 (53%) reported engaging in prohibited income generating activitiesin the past 30 days. Sex work and drug dealing accounted for the greatest amount of income generated.Non-aboriginal females were the group most likely to report prohibited income generation. Othervariables independently associated with prohibited income generation include daily heroin injection(AOR = 2.3) and daily use of crack cocaine (AOR = 3.5). Among these individuals, 68 (47%)indicated they would forgo these earnings if they did not require money for illegal drugs, with thoseengaged in sex trade work (62%) being most willing to give up their illegal source of income.Conclusion—These findings suggest that the costs associated with illicit drugs are compellingIDU, particularly those possessing markers of higher intensity addiction, to engage in prohibitedincome generating activities. These findings also point to an opportunity to explore interventionsthat relieve the financial pressure of purchasing illegal drugs and reduce engagement in suchactivities, such as low threshold employment and expansion of prescription and substitutiontherapies.KeywordsIDU; Income Generation; Sex Trade Work; Drug Dealing1. IntroductionTraditionally, society has attempted to discourage psychoactive drug use by employing a rangeof law enforcement tactics. These approaches have been shown to inflate the price of illegaldrugs. The high costs associated with illegal substances may deter and regulate drug use amongSend correspondence to: Thomas Kerr, PhD, BC Centre for Excellence in HIV/AIDS; University of British Columbia, St. Paul's Hospital,608-1081 Burrard Street, Vancouver, B.C. V6Z 1Y6, CANADA, Tel: (604) 806-9116, Fax: (604) 806-9044, Email: tkerr@cfenet.ubc.caPublisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customerswe are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resultingproof before it is published in its final citable form. Please note that during the production process errors may be discovered which couldaffect the content, and all legal disclaimers that apply to the journal pertain.NIH Public AccessAuthor ManuscriptDrug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.Published in final edited form as:Drug Alcohol Depend. 2007 November 2; 91(1): 50–56.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptcertain individuals (Benson et at., 2001); however, other drug users may resort to various formsof prohibited activities, including drug dealing, sex trade work and acquisitive crime to generatesufficient income to support their preferred level of drug consumption (Casavant and Collin,2001;Benson et al., 1992;Brochu et al. 1999;Haynes 1998;Nurco 1987).Past investigations have established a strong link between drug dependency and prohibitedincome generating activities (Stevens et al., 2003;Sherman and Latkin, 2002;Fischer et al.,2001;Deschenes and Anglin, 1991;Silverman and Spruill, 1977). High levels of prohibitedactivity have also been found to coincide with periods of heavy drug consumption (Grapendaal,et al., 1995;Nurco et al., 1985;Ball et al., 1983). Additionally a lack of employable job skills,past criminal histories and high profits derived from drug dealing have been identified as factorsinfluencing substance dependent individuals to engage in prohibited income generatingbehaviour (Sherman et al., 2006;Rothbard et al., 1999;Bretteville-Jensen and Sutton,1996;Hammersley et al., 1989).Prohibited income generating activities have a number of potential negative impacts onindividuals and society. In 2002 the Canadian Centre on Substance Abuse found that in Canadaover 20% of federal inmates report that they committed their most serious offence in order toobtain illegal drugs (Pernanen et al., 2002). The costs of incarcerating substance addictedindividuals for their criminal income generating acts is only one aspect of the negative socialimpacts of this phenomenon. Theft, fraud and other types of acquisitive crime financiallyburden society and activities that surround drug dealing have been associated with publicnuisances and increased drug consumption by making illegal substances readily available(Bretteville-Jensen and Sutton, 1996). Additionally, confrontations related to the illegal drugmarket account for the majority of violent interactions involving drug users (Casavant andCollin, 2001;Erickson 2001;Caulkins and Reuter, 1996), making drug dealing a dangerousactivity.Involvement in the sex trade industry is also associated with significant health risks and socialcosts. In Canada the sale of sexual services between consenting adults is legal; however,provisions regarding bawdy houses, procuring and communicating make many of the actssurrounding sex trade work illegal. In turn sex trade workers operate in an inherently dangerousunsanctioned environment which threatens their health and safety (Goodyear et al.,2005;Blankenship and Koester, 2002).The relationship between negative health outcomes and activities such as panhandling andsalvaging recyclable materials (binning) may appear less direct. However, major urban cities,including the City of Vancouver, Canada, have identified such activities as potential economicthreats to urban cores as some citizens report feeling unsafe around individuals engaging inthese activities and therefore may avoid affected areas. Similarly, there are concerns that a highprevalence of panhandling and binning threatens the public image of affected cities and therebyhas the potential to deter tourism and foreign investment (City of Vancouver, 2006). In anumber of major cities in North America (e.g., Toronto, Atlanta, Baltimore, Cincinnati, NewHaven, New York City, Philadelphia, Portland, San Francisco, and Seattle) policy makers haveintroduced legislation to increase the ability of law enforcement to arrest and prosecuteindividuals for panhandling and engaging in other undesirable behaviour (New York StateLaw, 2006;Safe Streets Act 1999;).While previous studies have identified prohibited income generation among injection drugusers (IDU) (Sherman and Latkin, 2002), there have been few studies that have assessed thecharacteristics of IDU who engage in such activities. As well, there have been few studies thathave detailed the amount of income derived from various prohibited sources and examined therole of ongoing drug use in perpetuating engagement in different prohibited income generatingDeBeck et al. Page 2Drug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptactivities. Therefore, we sought to explore the prevalence of and factors associated withengaging in prohibited income generating activities among a community-recruited cohort ofIDU. We also sought to shed light on the relationship between the costs associated withpurchasing illegal substances and motivations for engaging in prohibited income generatingactivity among IDU.2. MethodsBeginning in May 1996, persons who had injected illegal drugs in the previous month wererecruited into the Vancouver Injection Drug User Study (VIDUS), a prospective cohort studythat has been described in detail previously (Tyndall et al., 2002;Wood et al., 2001). Briefly,persons were eligible for the VIDUS study if they had injected illegal drugs at least once inthe previous month, resided in the greater Vancouver region, and provided written informedconsent. At baseline and semi-annually subjects provided blood samples and completed aninterviewer-administered questionnaire. Participants receive $20 for each study visit. Thequestionnaire elicits demographic data as well as information about drug use, income sources,HIV risk behavior and drug treatment. The study has been approved by the University of BritishColumbia's Research Ethics Board. The present analysis is restricted to those participants whowere actively injecting drugs and seen for follow-up during the period June, 2005 to December,2005. Analysis variables are available only for this sample period.Respondents were asked to identify all income sources over the past 30 days. Categories ofincome sources included; social assistance (including disability, pensions and other forms ofgovernment transfers), family and friends, paid work (including under the table employment),binning (includes salvaging recyclable materials), sex trade work, drug dealing, criminalactivity (category encompasses remaining criminal activity including theft, break and entry,robbery, fraud, etc.,) and panhandling. Respondents were then asked “If you didn't need themoney to pay for your drug use, are there any sources of income in the last 30 days that youwould eliminate?”. Those who responded ‘yes’ were then asked to indicate the specific incomesources they would choose to eliminate.To assess the prevalence of, and determine factors associated with, participation in prohibitedincome-generating activities the categories for sex trade work, drug dealing, criminal activity,binning and panhandling were combined into a separate category titled ‘prohibited activities’which served as a dependent variable of interest for subsequent analyses. However, we alsoconsidered a second dependent variable which consisted of only sex trade work, drug dealingand other criminal activity as a means of determining if there were meaningful differenceswhen the less risky activities of binning and panhandling were excluded from the analysis.Socio-demographic variables of interest considered in analyses included: age (per year older),gender (female versus male), ethnicity (Aboriginal versus non-Aboriginal), and homelessness(defined as having no fixed address for the last six months). Behavioral and drug use variables,based on activities in the last six months, included: frequent heroin injection (consistentlyinjecting once or more per day), frequent cocaine injection (consistently injecting once or moreper day), frequent crack use (consistently smoking once or more per day), syringe borrowing(at some time in last six months), syringe lending (at some time in last six months), enrolmentin any addiction treatment program (at some time in last six months) and injecting in publicspaces (defined as having at some time in the last six month injected on public streets, in alleys,public washrooms, parks and abandoned buildings). All definitions have been used previously(Wood et al., 2001).For the primary analysis, univariate and multivariate statistics were used to determine factorsassociated with engaging in any prohibited activity. In univariate analysis categoricalDeBeck et al. Page 3Drug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptexplanatory variables were analyzed using Pearson's Chi-square test and continuous variableswere analyzed using the Wilcoxon rank sum test. To evaluate factors independently associatedwith engaging in any prohibited activity, all variables of interest were entered into a fixedmultivariate logistic regression model. Using the same independent variables of interest, aseparate logistic regression model was constructed to examine factors associated with only themore restricted set of riskier prohibited activities (i.e., sex trade work, drug dealing, and othercriminal activities). We also assessed all two-way interactions.In sub analyses, three separate linear regression models, which included the same independentvariables of interest, were constructed to identify factors predicting the amount of incomegenerated through prohibited activities, as well as predictors of the number of days in the lastmonth spent involved in drug dealing and sex trade work respectively. In further sub analyses,we constructed two separate logistic regression models seeking to identify predictors ofwillingness to give up sex trade work and willingness to give up drug dealing.3. ResultsDuring the study period, 465 individuals completed follow-up visits and 275 (59%) reportedactive injection drug use. Of the 275 active injecting participants eligible for this analysis 127(46%) were women and the median age of participants was 39 (IQR = 30–47). As indicated inTable 1, a total of 145 (53%) study participants reported having generated income throughprohibited activities in the last 30 days, while 118 (43%) reported engaging in at least one ofthe restricted set of riskier prohibited activities (i.e., sex trade work, drug dealing, and othercriminal activity). The median number of prohibited activities that participants engaged in was1 (IQR = 1). The median number of days spent participating in income generating activities(16 days, IQR: 8 - 30) was the same when the broader and more restricted set of prohibitedincome activities were considered.Drug dealing was the most frequently reported prohibited source of income (n=74, 27%)followed by sex trade work (n=50, 18%). Of note, women were more likely than men to reportsex trade work [n=47 (37%) vs. n=3 (2%)]. The median monthly income earned through drugdealing was reported to be $1,500 (IQR: 400-4,500) and $1,000 (IQR: 220-2,200) for sex tradework. The category that encompassed all other criminal activity was the least frequentlyreported source of income among respondents (n= 12, 4%). The majority of our sample (n=231, 84%) reported income from some form of social assistance in the last 30 days. The medianincome derived from social assistance was $800 (IQR: 530-990). Other sanctioned incomesources generated relatively less income, and only a small proportion of respondents reportedearnings through paid work (n= 38, 14%).As indicated in Table 1, among individuals who reported income from any prohibited activity(n=145), 68 (47%) indicated they would no longer engage in the reported prohibited activitiesif they did not need money for drugs. Among those who reported income from sex trade work,31 (62%) indicated they would no longer engage in sex trade work if they did not require moneyfor drugs. Further, 30 (41%) respondents reporting income from drug dealing, 6 (50%)respondents reporting engaging in other criminal behavior, 10 (40%) respondents reportingpanhandling and 1 (5%) respondent who reported binning stated that they would eliminatethese respective income sources if they did not require money to pay for illegal substances.The univariate analyses of associations between independent variables of interest andengagement in prohibited income generating activities are shown in Table 2. As indicated,frequent crack use (OR = 4.6, 95% CI: 2.6 – 7.2), syringe lending (OR = 4.2, 95% CI: 1.4 –12.8), frequent heroin use (OR = 2.7, 95% CI: 1.7 – 4.6), public injecting (OR = 2.7, 95% CI:DeBeck et al. Page 4Drug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscript1.4 – 5.5), female gender (OR = 2.5, 95% CI: 1.5 - 4.0) and homelessness (OR = 2.5, 95% CI:1.3 – 5.0) were positively associated with engaging in prohibited income generating activities.When examining potential interactions between variables of interest, an interaction effect wasidentified between gender and ethnicity. This interaction was driven by sex trade beingdominated by non-aboriginal females. To account for this, a new class variable was defined tocombine gender and ethnicity whereby the reference group was non-aboriginal females. Theseclass variables were included along with all other variables of interest in the multivariatelogistic regression models.When all prohibited activities were considered (see Table 3), the group most strongly associatedwith reporting prohibited income generation were non-aboriginal females. Frequent crack use(Adjusted Odds Ratio [AOR] = 3.5, CI: 1.9 – 6.2), and frequent heroin injection (AOR = 2.3,CI: 1.3 – 4.1) also remained positively associated with prohibited income generating activitiesin multivariate analyses. The results remained the same when the dependent variable wasrestricted to sex trade work, drug dealing, and other criminal activity. Both models arepresented in Table 3.In sub analyses, data representing the amounts of income earned through prohibited activitieswere converted for use in linear regression models through log transformation to address highlyskewed data (range = $40 - $30,000). In the resulting analysis presented in Table 4, frequentheroin injection and frequent crack use where found to be statistically significant predictors ofamount of income earned (p < 0.05). Specifically, frequent heroin injectors reported earning97.4% more income from prohibited sources, and frequent crack users reported earning 197.4%more income from prohibited sources. Other sub analyses attempting to model the predictorsof the number of days spend in the last month engaging in drug dealing activities and sex tradework failed to produce significant results, due in part to low event counts. Models seeking toidentify predictors of willingness to give up drug dealing and sex trade work also failed toproduce significant findings, again due in part to low event counts.4. DiscussionIn the present study, we found that 53% of our active IDU sample reported generating incomethrough prohibited activities, with drug dealing and sex trade work found to be the mostprevalent sources of income. Factors independently associated with engaging in prohibitedincome generating activities were frequent crack use and frequent heroin injection. Non-aboriginal females were the group most strongly associated with prohibited income generation;however, it is important to note that aboriginal females were also more likely than males (bothaboriginal and non-aboriginal) to report prohibited income generation. This finding should notbe interpreted to indicate that aboriginal females are not a high-risk group as previous researchhas identified an association between aboriginal females and risky drug use practices (Craibet al., 2003). In total, 67 (46%) individuals who reported obtaining income from prohibitedsources said they would give up this source of income if they did not need money for drugs,with those who reported earning money through sex trade work being most likely to report thatthey would eliminate this source of income if they did not require money for drugs.Consistent with previous studies, a substantial proportion of IDU generate income throughprohibited activities (Fischer et al., 1999;Bretteville-Jensen and Sutton, 1996), and thoseengaging in such activities possess several markers of higher intensity addiction (Sherman andLatkin 2002;Grapendaal et al., 1995). Also consistent with other studies (Bretteville-Jensenand Sutton, 1996;Grapendaal et al., 1995); social security was the most prevalently reportedsource of income followed by drug dealing and sex trade work, and women were more likelyDeBeck et al. Page 5Drug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptthan men to engage in prohibited income generation; a finding largely driven by a much higherproportion of women engaging in sex trade work.The rates of involvement in sex trade work and drug dealing found in our study are alarminggiven the previously identified health and social harms associated with these activities,including violence. Furthermore, participation in any of the prohibited activities explored inthe current study increases the risk of arrest and incarceration, which has been shown to be apredictor of HIV infection among local IDU (Wood et al., 2005;Small et al., 2005). As indicatedby our multivariate analyses, females and those involved in high intensity drug use appear tobe most vulnerable to dangers associated with prohibited income generating activities.A central implication of our findings is that a portion of the prohibited income generation ofactive IDU, and the harms associated with them, are a function of the costs associated withillegal drugs. By disrupting drug markets and increasing risks involved in producing anddistributing illegal substances, prohibition-based drug enforcement policies play a role ininflating drug prices (Reuter and Kleiman, 1986;Caulkins and MacCoun, 2003;Boyum andKleiman, 2001), which in turn induces active IDU with high intensity addictions to engage inprohibited income generating behavior to finance their drug use. While the ultimate objectiveof inducing high drug prices is to deter drug use (Caulkins and Reuter, 1996; Office of NationalDrug Control Strategy 2006), this analysis and a growing body of research indicates that theunintended consequences of these enforcement-based policies produce significant harm fordrug using individuals and broader society (Small et al., 2006;Cooper et al., 2005;Kerr et al.,2005;Wood et al., 2004;Aitken et al., 2002;Blankenship and Koester, 2002;Maher and Dixon,1999). It is important that policy makers recognize these realities and balance the perceivedbenefits of criminal-prohibition with other associated outcomes, such as increased levels ofcrime and IDU engagement in risky prohibited income generating activitiesWhile this analysis suggests that higher intensity addiction and the costs associated withpurchasing illegal drugs are central factors influencing active IDU to engage in prohibitedincome generating activities, the lack of available alternative income sources is also animportant aspect of this relationship. Many active IDU have difficulty finding sufficientlegitimate paid work due in part to unstable housing, limited employable skills and low levelsof education (Sherman et al., 2006). One alternative for these individuals is to obtain incomeassistance and other forms of social assistance; however, income analysis in the present studyfound the median income from social assistance to be $800, which for most IDU is insufficientto support a secure living and habitual drug consumption (Casavant and Collin, 2001;Fischeret al., 1999). Furthermore, the current structure of social assistance in Canada is such thatrecipients will lose their income benefits if they begin to earn above $400 per month throughlegitimate work, leaving this population with limited income generating options beyondresorting to prohibited sources.Given the association between amount of prohibited income generated and high intensityaddiction, the findings of the present study highlight the importance of introducing targetedinterventions which focus on individuals with higher intensity addictions. One method of tryingto reduce engagement in prohibited income generation among drug user populations withsevere addictions is to expand their economic opportunities. This would involve supportingthe development of legitimate means of earning income through various low thresholdemployment opportunities and skill building measures. A recent intervention designed toeconomically empower drug addicted sex trade workers to develop alternative legitimatesources of income has been shown to have a positive influence on reducing involvement in thesex trade industry (Sherman et al., 2006). Alternatively, policy makers could intervene byproviding addiction prescription and substitution therapies to individuals with markers ofserious addiction to decrease their reliance on, and subsequent need to purchase, street drugs.DeBeck et al. Page 6Drug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptThis could be achieved in part through heroin prescription programs and by expandingsubstitution therapies including methadone maintenance. However, given the high prevalenceof stimulant use both locally and globally (World Drug Report 2006; Adlaf et al., 2005;Buxton2005), opiate substitution therapies will have a limited impact, and therefore continuedexploration of stimulant replacement therapies is desirable. These types of interventions wouldboth reduce criminal activity and remove profits from criminal organizations.There are several limitations in this study to be noted. First, as with most other cohort studiesof IDU, the VIDUS study is not a random sample, and therefore these findings may notgeneralize to other IDU populations. Secondly, this study relied on self-reported informationconcerning sources and amounts of income, as well as predictions of future behavior intheoretical situations and is hence susceptible to recall bias as well as socially desirablereporting. In the present study this may have led to an under-reporting of income derivedthrough criminal activities. Thirdly, reported income sources do not account for ‘in-kind’transactions. A likely result is that the true monetary profits in the drug dealing category areunder reported as many individuals purchase large quantities of drugs to offset the cost of theirown consumption or are paid in drugs rather than money for drug dealing work (Bretteville-Jensen and Sutton, 1996). Similarly, sex for drugs exchanges are also not considered in thisanalysis. As the benefits from these informal exchanges are not reported as income our analysislikely underestimates the extent to which the costs associated with purchasing drugs encouragedrug dealing and sex work to support illegal substance use.In sum, our study suggests that the high costs associated with illegal drugs are particularlyproblematic for females (largely driven by the high proportion of female involvement in sextrade work) and those possessing markers of high intensity addiction, and these costs likelyserve to encourage and perpetuate engagement in illegal income generating activities.Collectively these findings indicate an opportunity to explore the benefits of developing lowthreshold employment opportunities and prescription and substitution therapies.ReferencesAdlaf, E.; Begin, P.; Sawka, E. 2004 Canadian Addiction Survey (CAS): A national survey of Canadians'use of alcohol and other drugs: Prevalence of use and related harms: Detailed report. Canadian Centreon Substance Abuse; Ottawa: 2005.Aitken C, Moore D, Higgs P, Kelsall J, Kerger M. The impact of a police crackdown on a street drugscene: evidence from the street. Int J Drug Policy 2002;3:189–198.Ball J, Shaffer J, Nurco D. The day to-day criminality of heroin addicts in Baltimore -- A study in thecontinuity of offence rates. Drug Alcohol Depend 1983;12(2):119–142. [PubMed: 6653385]Benson B, Kim I, Rasmussen D, Zuehlke T. Is property crime caused by drug use or by drug enforcementpolicy? Appl Econ 1992;24:679–692.Benson B, Leburn I, Rasmussen D. The impact of drug enforcement on crime: An investigation of theopportunity cost of police resources. J Drug Issues 2001;31(4):989–1006.Blankenship KM, Koester S. Criminal law, policing policy, and HIV risk in female street sex workersand injection drug users. J Law Med Ethics 2002;30(4):548–59. [PubMed: 12561263]Boyum, D.; Kleiman, M. Substance Abuse Policy from a Crime-Control Perspective. In: Wilson, J.;Petersilia, J., editors. Crime. 2nd. ICS Press; San Francisco, California: 2001.Bretteville-Jensen A, Sutton M. The income-generating behaviour of injecting drug-users in Oslo.Addiction 1996;91(1):63–79. [PubMed: 8822015]Brochu, S.; Cournoyer, L.; Motiuk, L.; Pernanen, K. Bulletin on Narcotics. LI. 1999. Drugs, alcohol andcrime: patterns among Canadian federal inmates. Available at: http://www.unodc.org/unodc/bulletin/bulletin_1999-01-01_1_page006.html (accessed on May 17 2006)DeBeck et al. Page 7Drug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptBuxton, J. Canadian Community Epidemiology Network on Drug Use. 2005. Vancouver Drug UseEpidemiology. Available at: http://ir.lib.sfu.ca/retrieve/2734/Chodarr0139.pdf (accessed on June 202006)Casavant, L.; Collin, C. Parliamentary Research Branch. Library of Parliament; Ottawa, Ontario,: 2001.Illegal Drug Use and Crime: A complex relationship: Prepared for the Special Senate Committee onIllegal Drugs. Available at: http://www.parl.gc.ca/37/1/parlbus/commbus/senate/com-e/ille-e/library-e/collin-e.htm (accessed on August 10 2006)Caulkins J, MacCoun R. Limited rationality and the limits of supply reduction. J Drug Issues 2003;33(2):433.Caulkins J, Reuter P. The meaning and utility of drug prices. Addiction 1996;91(9):1261–4. [PubMed:8854356]City of Vancouver. Project civil city: Office of the Mayor. 2006. Available at: http://www.mayorsamsullivan.ca/pdf/project-civil-city.pdf (accessed on April 15 2007)Cooper H, Moore L, Gruskin S, Krieger N. The impact of a police drug crackdown on drug injectors'ability to practice harm reduction: A qualitative study. Soc Sci Med 2005;61(3):673–684. [PubMed:15899325]Craib K, Spittal P, Wood E, Laliberte N, Hogg R, Li K, Heath K, Tyndall M, O'Shaughnessy M, SchechterM. Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver.Cmaj 2003;68(1):19–24. [PubMed: 12515780]Deschenes E, Anglin M. Narcotics addiction: Related criminal careers, social and economic costs. J DrugIssues 1991;21(2):383.Erickson, P. Sensible Solutions to the Urban Drug Problem. Fraser Institute Digital Publications; 2001.Drugs, violence and public health: What does harm reduction approach have to offer?. Available at:http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=271 (accessed on May 17 2006)Fischer B, Medved W, Gliksman L, Rehm J. Illicit Opiates in Toronto: A profile of current users.Addiction Research 1999;7(5):377.Fischer B, Medved W, Kirst M, Rehm J, Gliksman L. Illicit opiates and crime: Results of an untreateduser cohort study in Toronto. Can J Criminol 2001;43(2):197–217.Grapendaal, M.; Leuw, E.; Nelen, H. A world of opportunities : life-style and economic behavior ofheroin addicts in Amsterdam. State University of New York Press; Albany: 1995.Goodyear M, Lowman J, Fischer B, Green M. Prostitutes are people too. Lancet 2005;366:1264–1265.[PubMed: 16214593]Hammersley R, Forsyth A, Morrison V, Davies J. The relationship between crime and opioid use. Br JAddict 1989;84(9):1029. [PubMed: 2790266]Haynes P. Drug Using Offenders in South London: Trends and Outcomes. J Subst Abuse Treat 1998;15(5):449–456. [PubMed: 9751004]Kerr T, Small W, Wood E. The public health and social impacts of drug market enforcement: A reviewof the evidence. Int J Drug Policy 2005;16(4):210–220.Maher L, Dixon D. Policing and public health: Law enforcement and harm minimization in a street-leveldrug market. Br J Criminol 1999;39(4):488–512.New York State Law Reporting Bureau. People of the State of New York v Barton. 2006. Available at:http://www.nycourts.gov/ctapps/decisions/dec06/176opn06.pdf (accessed March 10 2007)Nurco D. Drug addiction and crime: A complicated issue. Br J Addict 1987;82(1):7. [PubMed: 3470045]Nurco D, Cisin I, Ball J. Crime as a source of income for narcotic addicts. J Subst Abuse Treat 1985;2(2):113–115. [PubMed: 3831370]Office of National Drug Control Policy. National Drug Control Strategy. White House; Washington, D.C:2006. Available at: http://www.whitehousedrugpolicy.gov/publications/policy/ndcs06/. (accessedon May 17 2006)Pernanen, K.; Cousineau, M.; Brochu, S.; Sun, S. Canadian Centre on Substance Abuse. 2002. Proportionsof Crimes Associated with Alcohol and Other Drugs in Canada. Available at: http://www.ccsa.ca/NR/rdonlyres/2322ADF8-AF1E-4298-B05D-E5247D465F11/0/ccsa0091052002.pdf (accessedApril 15 2007)DeBeck et al. Page 8Drug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptReuter, P.; Kleiman, M. Risks and Prices. In: Tonry, M.; Morris, N., editors. Crime and Justice: A Reviewof Research. University of Chicago Press; Chicago: 1986. p. 289-340.Rothbard A, Alterman A, Rutherford M, Liu F, Zelinski S, McKay J. Revisiting the effectiveness ofmethadone treatment on crime reductions in the 1990s. J Subst Abuse Treat 1999;16(4):329–335.[PubMed: 10349606]Statutes of Ontario. Chapter 8. 1999. Safe Streets Act.Sherman S, German D, Cheng Y, Marks M, Bailey-Kloche M. The evaluation of the JEWEL project: Aninnovative economic enhancement and HIV prevention intervention study targeting drug usingwomen involved in prostitution. AIDS Care 2006;18(1):1. [PubMed: 16282070]Sherman SG, Latkin CA. Drug users' involvement in the drug economy: implications for harm reductionand HIV prevention programs. J U Health 2002;79(2):266–277.Silverman L, Spruill N. Urban crime and the price of heroin. J Urban Econ 1977;4(1):80–103.Small W, Kain S, Laliberte N, Schechter MT, O'Shaughnessy MV, Spittal PM. Incarceration, addictionand harm reduction: Inmates experience injecting drugs in prison. Subst Use and Misuse 2005;40(6):831–43.Small W, Kerr T, Charette J, Schechter MT, Spittal PM. Impacts of intensified police activity on injectiondrug users: Evidence from an ethnographic investigation. Int J Drug Policy 2006;17(2):85–95.Stevens, A.; Berto, D.; Kerschl, V.; Oeuvray, K.; van Ooyen, M.; Steffan, E.; Heckmann, W.;Uchtenhagen, A. Summary Literature Review: The international literature on drugs, crime andtreatment. QCT Europe Partners: European Institute of Social Services; Canterbury: 2003. Availableat: http://www.kent.ac.uk/eiss/Documents/pdf_docs/QCT%20Europe%20summary%20lit%20review.pdf (accessed April 15 2007)Tyndall M, Spittal P, Laliberte N, Li K, O'Shaughnessy M, Schechter M. Intensive injection cocaine useas a primary risk factor of HIV seroconversion among polydrug users in Vancouver. AIDS 2002;17(6):887–893. [PubMed: 12660536]United Nations Office on Drugs and Crime. World Drug Report. United Nations; 2006.Wood E, Montaner J, Kerr T. HIV risks in incarcerated injection-drug users. Lancet 2005;366(9500):1834–1835. [PubMed: 16310539]Wood E, Spittal P, Small W, Kerr T, Li K, Hogg R, Tyndall M, Montaner J. Displacement of Canada'slargest public illicit drug market in response to a police crackdown. Can Med Assoc J 2004;170:1551–1556. [PubMed: 15136548]Wood E, Tyndall MW, Spittal PM, Li K, Kerr T, Hogg RS, Montaner JS, O'Shaughnessy MV, SchechterMT. Unsafe injection practices in a cohort of injection drug users in Vancouver: could safer injectingrooms help? Can Med Assoc J 2001;165(4):405–10. [PubMed: 11531048]DeBeck et al. Page 9Drug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptDeBeck et al. Page 10Table 1Study participants' (n=275) sources of income in the last 30 days.Income SourceN (%) reporting activityMedian income (IQR)*Median days engaged in activity(IQR)N (%) would give up activity**Social Assistance231(84)800(530-990)--Drug Dealing†‡74(27)1,500(400-4,500)17(10-30)30(41)Sex Trade Work†‡50(18)1,000(220-2,200)10(5-20)31(62)Paid Work38(14)620(225-1,350)6(4-20)-Panhandling‡25(9)500(110-1,200)20(10-30)10(40)Family and Friends21(8)275(100-600)--Binning‡19(7)200(70-400)12(5-20)1(5)Criminal Activity†‡12(4)600(300-1,500)20(2-30)6(50)All Prohibited Activities145(53)1,000(300-3,000)16(8-30)68(47)Restricted ProhibitedActivities118(43)1,000(360-4,000)16(8-30)62(53)* Refers to amount of income generated in the last 30 days in dollars**Data recorded only for prohibited activities‡ Are activities included in the ‘all prohibited activities’ category† Are activities included in the ‘restricted prohibited activities’ categoryDrug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptDeBeck et al. Page 11Table 2Univariate analyses of study participants' characteristics stratified by those who did and did not report prohibited income sources.Prohibited income source*CharacteristicsYesn, (%)Non, (%)OR†95% CIMedian Age (IQR)‡36 (16)41 (13)1.0(0.9 – 1.0)Frequent Crack Use†Yes99 (70)43 (30)4.6(2.6 – 7.2)No46 (35)87 (65)Syringe Lending†Yes17 (81)4 (19)4.2(1.4 – 12.8)No128 (50)126 (50)Frequent Heroin Use†Yes75 (68)36 (32)2.7(1.7 – 4.6)No70 (43)94 (57)Public Injecting†Yes34 (72)13 (28)2.7(1.4 – 5.5)No111 (49)117 (51)GenderF82 (65)45 (35)2.5(1.5 – 4.0)M63 (43)85 (57)Homelessness†Yes34 (71)14 (29)2.5(1.3 – 5.0)No111 (49)116 (51)Syringe Borrowing†Yes13 (62)8 (38)1.5(0.6 – 3.7)No132 (52)122 (48)Frequent Cocaine Use†Yes33 (52)30 (48)1.0(0.6 – 1.7)No112 (53)100 (47)Addiction Treatment†Yes76 (50)76 (50)0.8(0.5 – 1.3)No69 (56)54 (44)Aboriginal EthnicityYes40 (48)43 (52)0.8(0.5 – 1.3)No105 (55)87 (45)OR = Odds Ratio; CI = Confidence Interval.* Prohibited income categories include; sex trade work, drug dealing, other criminal activity, panhandling, and binning.‡ Age per year older.† Denotes activities or situations referring to previous 6 months.Drug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptDeBeck et al. Page 12Table 3Logistic regression analysis of factors associated with partaking in prohibited income generating activities.Analysis of all prohibited activities* Analysis of restricted prohibitedactivities**Variable AOR 95% CI AOR 95% CIAge (Per year older) 1.0 (1.0 – 1.0) 1.0 (1.0 – 1.0)Frequent Cocaine Inject† (Yes versus No) 0.6 (0.3 – 1.2) 0.7 (0.4 – 1.4)Frequent Crack Use† (Yes versus No) 3.5 (1.9 – 6.2) 3.6 (2.0 – 6.4)Frequent Heroin Inject† (Yes versus No) 2.3 (1.3 – 4.1) 2.6 (1.5 – 4.6)Syringe Borrowing† (Yes versus No) 0.9 (0.3 – 3.0) 0.8 (0.3 – 2.6)Syringe Lending† (Yes versus No) 2.7 (0.8 – 9.8) 2.3 (0.7 – 7.1)Public Injecting† (Yes versus No) 1.4 (0.6 – 3.4) 1.1 (0.5 – 2.5)Homelessness† (Yes versus No) 1.6 (0.7 – 3.8) 1.1 (0.5 – 2.5)Addiction Treatment† (Yes versus No) 0.7 (0.4 – 1.2) 0.8 (0.4. – 1.4)Non-Aboriginal Female (Reference) 1.0 --REF-- 1.0 --REF--Aboriginal Female (Yes versus Reference) 0.3 (0.1 – 0.7) 0.5 (0.2 – 1.0)Non-Aboriginal Male (Yes versus Reference) 0.4 (0.2 – 0.7) 0.4 (0.2 – 0.7)Aboriginal Male (Yes versus Reference) 0.2 (0.1 – 0.7) 0.3 (0.1 – 0.9)AOR = Adjusted Odds Ratio; CI = Confidence Interval.*All prohibited activities include the following categories= sex trade, drug dealing, other criminal activities, panhandling and binning.**Restricted prohibited activities include the following categories =sex trade work, drug dealing, other criminal activities.†Denotes activities or situations referring to previous 6 months.Drug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptDeBeck et al. Page 13Table 4Linear regression of factors associated with income generated from prohibited activities*Variable Coefficient (β) SE t value p-valueIntercept 6.78 0.78 8.59 < 0.01Frequent Heroin Injection† 0.68 0.28 2.41 0.02Frequent Crack Use† 1.09 0.32 3.37 < 0.01SE = Standard Error.*Prohibited activities include the following categories= sex trade, drug dealing, other criminal activities, panhandling and binning.†Denotes activities or situations referring to previous 6 months.Income data was logged. Model was adjusted for: age, gender, aboriginal ethnicity, frequent cocaine injection, syringe borrowing, syringe lending, publicinjecting, homelessness, and addiction treatmentDrug Alcohol Depend. Author manuscript; available in PMC 2007 November 2.


Citation Scheme:


Citations by CSL (citeproc-js)

Usage Statistics



Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            async >
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:


Related Items