Abstract
Objective: To assess the relationship between experiencing homelessness and assisting injection drug use (IDU) initiation among people who inject drugs (PWID) in Tijuana, Mexico and Vancouver, Canada.
Methods: We used self-reported questionnaire data collected semi-annually on PWID from Tijuana (n=703) and Vancouver (n=1,551) between 2014 and 2017. Within each setting, the effect of recent (i.e., past six months) homelessness on recent provision of injection initiation assistance (i.e., helping anybody inject for the first time in the past six months) was estimated using inverse-probability-of-treatment (IPT)-weighted estimation of a marginal structural model.
Results: Across follow-up, the prevalence of recent homelessness at a given visit ranged from 11.6%-16.5% among Tijuana-based participants and 9.4%-18.9% among Vancouver-based participants; the prevalence of recent provision of injection initiation at a given follow-up visit was lower, ranging from 3.3%-5.4% in Tijuana and 2.5%-4.1% in Vancouver. Based on the IPT-weighted estimates, recent homelessness was associated with 66% greater odds among Tijuana-based PWID (Adjusted Odds Ratio [AOR] = 1.66; 95% CI: 1.01 to 2.73) and 47% greater odds among Vancouver-based PWID (AOR = 1.47, 95% CI: 1.02 to 2.13) of providing injection initiation assistance over the same six-month period.
Conclusion: We found that recently experiencing homelessness was associated with an increased likelihood of PWID reporting IDU initiation assistance over time in both Tijuana and Vancouver. Addressing homelessness may decrease the initiation of IDU via multiple pathways.
Methods: We used self-reported questionnaire data collected semi-annually on PWID from Tijuana (n=703) and Vancouver (n=1,551) between 2014 and 2017. Within each setting, the effect of recent (i.e., past six months) homelessness on recent provision of injection initiation assistance (i.e., helping anybody inject for the first time in the past six months) was estimated using inverse-probability-of-treatment (IPT)-weighted estimation of a marginal structural model.
Results: Across follow-up, the prevalence of recent homelessness at a given visit ranged from 11.6%-16.5% among Tijuana-based participants and 9.4%-18.9% among Vancouver-based participants; the prevalence of recent provision of injection initiation at a given follow-up visit was lower, ranging from 3.3%-5.4% in Tijuana and 2.5%-4.1% in Vancouver. Based on the IPT-weighted estimates, recent homelessness was associated with 66% greater odds among Tijuana-based PWID (Adjusted Odds Ratio [AOR] = 1.66; 95% CI: 1.01 to 2.73) and 47% greater odds among Vancouver-based PWID (AOR = 1.47, 95% CI: 1.02 to 2.13) of providing injection initiation assistance over the same six-month period.
Conclusion: We found that recently experiencing homelessness was associated with an increased likelihood of PWID reporting IDU initiation assistance over time in both Tijuana and Vancouver. Addressing homelessness may decrease the initiation of IDU via multiple pathways.
Original language | English |
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Article number | 108829 |
Journal | Drug and Alcohol Dependence |
Volume | 225 |
Early online date | 24 Jun 2021 |
DOIs | |
Publication status | Published - 1 Aug 2021 |
Bibliographical note
Funding Information:PRIMER and Dan Werb are supported by a US National Institute on Drug Abuse Avenir Award (DP2- DA040256-01), the Canadian Institutes of Health Research (CIHR) via a New Investigator Award, the Ontario Ministry of Research, Innovation and Science via an Early Researcher Award, and the St. Michael's Hospital Foundation. El Cuete IV was supported through NIDA grant R37 DA019829. VIDUS and ARYS are supported by NIDA grant U01DA038886, and the ACCESS Study is supported by NIDA grant U01DA0251525. Kanna Hayashi is the St. Paul's Hospital Chair in Substance Use Research and is supported by NIDA grant U01DA03886, a CIHR New Investigator Award, and a Michael Smith Foundation for Health Research Scholar Award. M-J Milloy is supported by NIDA grant U01DA0251525, a CIHR New Investigator Award, and a Michael Smith Foundation for Health Research Scholar Award. M-J Milloy is the Canopy Growth professor of cannabis science at UBC, a position created using unstructured arms? length gifts to the university from Canopy Growth Corporation, a licensed producer of cannabis, and the Government of British Columbia's Ministry of Mental Health and Addictions. Steffanie Strathdee is supported by a US NIDA MERIT AwardR37DA019829). Kora DeBeck is supported by a Michael Smith Foundation for Health Research/St. Paul's Hospital-Providence Health Care Career Scholar Award. Funding sources had no additional role in the design of this study, in the collection, analysis, and interpretation of the data, nor in the writing of this report.
Funding Information:
PRIMER and Dan Werb are supported by a US National Institute on Drug Abuse Avenir Award ( DP2- DA040256-01 ), the Canadian Institutes of Health Research (CIHR) via a New Investigator Award , the Ontario Ministry of Research, Innovation and Science via an Early Researcher Award , and the St. Michael’s Hospital Foundation . El Cuete IV was supported through NIDA grant R37 DA019829. VIDUS and ARYS are supported by NIDA grant U01DA038886 , and the ACCESS Study is supported by NIDA grant U01DA0251525 . Kanna Hayashi is the St. Paul’s Hospital Chair in Substance Use Research and is supported by NIDA grant U01DA03886 , a CIHR New Investigator Award , and a Michael Smith Foundation for Health Research Scholar Award . M-J Milloy is supported by NIDA grant U01DA0251525, a CIHR New Investigator Award, and a Michael Smith Foundation for Health Research Scholar Award. M-J Milloy is the Canopy Growth professor of cannabis science at UBC, a position created using unstructured arms’ length gifts to the university from Canopy Growth Corporation, a licensed producer of cannabis, and the Government of British Columbia’s Ministry of Mental Health and Addictions. Steffanie Strathdee is supported by a US NIDA MERIT Award R37DA019829 ). Kora DeBeck is supported by a Michael Smith Foundation for Health Research/St. Paul’s Hospital-Providence Health Care Career Scholar Award . Funding sources had no additional role in the design of this study, in the collection, analysis, and interpretation of the data, nor in the writing of this report.
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© 2021