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Injecting drugs alone during an overdose crisis in Vancouver, Canada Norton, Alexa; Hayashi, Kanna; Johnson, Cheyenne; Choi, JinCheol; Milloy, M-J; Kerr, Thomas

Abstract

Background: Settings throughout Canada and the USA continue to experience crises of overdose death due to the toxic unregulated drug supply. Injecting drugs alone limits the potential for intervention and has accounted for a significant proportion of overdose deaths, yet the practice remains understudied. We sought to examine the practice of injecting alone among people who inject drugs (PWID) in Vancouver, Canada. Methods Data were derived from two prospective cohorts of people who use drugs between June 2016 and November 2018. This analysis was restricted to participants who, in the previous 6 months, reported any injection drug use. Rates of injecting alone were categorized as always, usually, sometimes, or occasionally. We fit a multivariable generalized linear mixed model to identify factors associated with injecting drugs alone. Results Among 1070 PWID who contributed 3307 observations, 931 (87%) reported injecting alone at least once during the study period. In total, there were 729 (22%) reports of always injecting alone, 722 (21.8%) usually, 471 (14.2%) sometimes, 513 (15.5%) occasionally, and 872 (26.4%) never. In a multivariable model, factors positively associated with injecting drugs alone included male sex (adjusted odds ratio [AOR] 1.69; 95% confidence interval [CI] 1.20–2.37), residence in the Downtown Eastside neighbourhood (AOR 1.43; 95% CI 1.08–1.91), binge drug use (AOR 1.36; 95% CI 1.08–1.72), and experiencing physical or sexual violence or both (AOR 1.43; 95% CI 1.00–2.03). Protective factors included Indigenous ancestry (AOR 0.71; 95% CI 0.52–0.98) and being in a relationship (AOR 0.30; 95% CI 0.23–0.39). Conclusion We observed that injecting alone, a key risk for overdose mortality, was common among PWID in Vancouver. Our findings underline the need for additional overdose prevention measures that are gender-specific, culturally appropriate, violence- and trauma-informed, and available to those who inject alone.

Item Metadata

Title
Injecting drugs alone during an overdose crisis in Vancouver, Canada
Creator
Norton, Alexa; Hayashi, Kanna; Johnson, Cheyenne; Choi, JinCheol; Milloy, M-J; Kerr, Thomas
Contributor
British Columbia Centre on Substance Use; St. Paul's Hospital (Vancouver, B.C.)
Publisher
BioMed Central
Date Issued
2022-11-17
Description
Background: Settings throughout Canada and the USA continue to experience crises of overdose death due to the toxic unregulated drug supply. Injecting drugs alone limits the potential for intervention and has accounted for a significant proportion of overdose deaths, yet the practice remains understudied. We sought to examine the practice of injecting alone among people who inject drugs (PWID) in Vancouver, Canada. Methods Data were derived from two prospective cohorts of people who use drugs between June 2016 and November 2018. This analysis was restricted to participants who, in the previous 6 months, reported any injection drug use. Rates of injecting alone were categorized as always, usually, sometimes, or occasionally. We fit a multivariable generalized linear mixed model to identify factors associated with injecting drugs alone. Results Among 1070 PWID who contributed 3307 observations, 931 (87%) reported injecting alone at least once during the study period. In total, there were 729 (22%) reports of always injecting alone, 722 (21.8%) usually, 471 (14.2%) sometimes, 513 (15.5%) occasionally, and 872 (26.4%) never. In a multivariable model, factors positively associated with injecting drugs alone included male sex (adjusted odds ratio [AOR] 1.69; 95% confidence interval [CI] 1.20–2.37), residence in the Downtown Eastside neighbourhood (AOR 1.43; 95% CI 1.08–1.91), binge drug use (AOR 1.36; 95% CI 1.08–1.72), and experiencing physical or sexual violence or both (AOR 1.43; 95% CI 1.00–2.03). Protective factors included Indigenous ancestry (AOR 0.71; 95% CI 0.52–0.98) and being in a relationship (AOR 0.30; 95% CI 0.23–0.39). Conclusion We observed that injecting alone, a key risk for overdose mortality, was common among PWID in Vancouver. Our findings underline the need for additional overdose prevention measures that are gender-specific, culturally appropriate, violence- and trauma-informed, and available to those who inject alone.
Subject
Injecting alone; Solitary injection; Using alone; People who inject drugs; Injection drug use; Overdose; Overdose prevention
Genre
Article
Type
Text
Language
eng
Date Available
2023-10-05
Provider
Vancouver : University of British Columbia Library
Rights
Attribution 4.0 International (CC BY 4.0)
DOI
10.14288/1.0436931
URI
http://hdl.handle.net/2429/86073
Affiliation
Applied Science, Faculty of; Medicine, Faculty of; Non UBC; Medicine, Department of; Nursing, School of
Citation
Norton, A., Hayashi, K., Johnson, C. et al. Injecting drugs alone during an overdose crisis in Vancouver, Canada. Harm Reduct J 19, 125 (2022).
Publisher DOI
10.1186/s12954-022-00701-w
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher; Graduate
Copyright Holder
The Author(s)
Rights URI
http://creativecommons.org/licenses/by/4.0/
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Rights

Attribution 4.0 International (CC BY 4.0)