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An interdisciplinary study of injection drug related harm among young people who use injection drugs in Vancouver, British Columbia Miller, Caroline Lisa

Abstract

Research Problem: Young injection drug users (IDUs) may be at elevated risk for blood-borne infection, however there is a dearth of longitudinal data regarding factors that influence drug-related harms in this population. Methods: This study was an interdisciplinary exploration of drug-related harm among young (< or = 29 years) IDUs in Vancouver, B.C., undertaken through the VIDUS, a prospective cohort that began in 1996. Over 1500 participants have been enrolled and followed, among whom over 550 were aged < or = 29 years. Participants were eligible for an interview semiannually and have undergone serologic testing for HIV and HCV antibodies. In addition to the longitudinal survey data, 28 participants (aged < or = 29 years) consented to an in-depth interview. Results: Cumulative incidence rates for HIV and HCV among young participants were 11.1% and 52.1% respectively at 36 months after enrollment [sic] in the study. In total, 38% of the young IDUs initiated injection drug use in early adolescence (< or = 16 years) and those who did were more likely to be: HIV and HCV-seropositive, female, sex workers, binge drug users and incarcerated. Younger (< or = 29 years [N=582]) and older (> or = 30 years [N=1016]) IDUs were compared in multivariable analyses and younger age was associated with: female sex, homelessness, incarceration, sex work, borrowing syringes, > or = 1 daily injection of heroin, cocaine, and speedballs and being less likely to access drug treatment or MMT. In quantitative and qualitative analyses examining associations between younger age and frequent heroin injection, data revealed numerous sex and drug-related vulnerabilities among younger IDUs associated with heroin dependency, initiation and withdrawal. 22 young IDUs died during the study period for a crude mortality rate of 1,368 per 100,000 person-years. Young female IDUs were 54.1 times (95%CI; 29.6-90.8) and young male IDUs 12.9 times (95%CI; 5.5, 25.3) more likely to die compared to the Canadian non-IDU population of the same age. Findings: Younger IDUs demonstrated unique and elevated risk patterns as compared to older IDUs, including elevated use of injection heroin and lower uptake of available treatment. Young IDUs, particularly females, require targeted and ’youth-friendly’ interventions including the development of substitution therapies, drug treatment, injection initiation prevention and harm reduction education services.

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