Requiring help injecting among people who inject drugs in Toronto, Canada: Characterising the need to address sociodemographic disparities and substance-use specific patterns

Sanjana Mitra; Gillian Kolla; Geoff Bardwell; Rick Wang; Ruby Sniderman; Kate Mason; Dan Werb; Ayden Scheim

doi:10.1111/dar.13473

Requiring help injecting among people who inject drugs in Toronto, Canada: Characterising the need to address sociodemographic disparities and substance-use specific patterns

Drug Alcohol Rev. 2022 Jul;41(5):1062-1070. doi: 10.1111/dar.13473. Epub 2022 May 16.

Authors

Sanjana Mitra^{1

2}, Gillian Kolla³, Geoff Bardwell^{2

4}, Rick Wang⁵, Ruby Sniderman⁵, Kate Mason⁶, Dan Werb^{7

8}, Ayden Scheim^{9

7}

Affiliations

¹ Interdisciplinary Graduate Studies Program, University of British Columbia, Vancouver, Canada.
² British Columbia Centre on Substance Use, Vancouver, Canada.
³ Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada.
⁴ Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada.
⁵ MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.
⁶ South Riverdale Community Health Centre, Toronto, Canada.
⁷ Centre on Drug Policy Evaluation, Unity Health Toronto, Toronto, Canada.
⁸ University of California San Diego School of Medicine, La Jolla, USA.
⁹ Dornsife School of Public Health, Drexel University, Philadelphia, USA.

PMID: 35577755
DOI: 10.1111/dar.13473

Abstract

Introduction: Those requiring help injecting are at an elevated risk of injection-related injury and blood-borne infections and are thus a priority group for harm reduction programs. As supervised consumption services (SCS) are scaled-up across Canada, information on those who require help injecting is necessary to inform equitable service uptake. We characterised the sociodemographic, structural and drug use correlates of needing help injecting among a cohort of people who inject drugs in Toronto, Canada.

Methods: A cross-sectional baseline survey was administered between November 2018 and March 2020. Unadjusted and multivariable logistic regression models examined associations with requiring help injecting in the past 6 months. A gender-stratified sub-analysis described characteristics of receiving help among those requiring it.

Results: Of 701 participants (31.0% cisgender women), 294 (41.9%) needed recent help injecting. In unadjusted analyses, being a racialised, non-Indigenous person (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.13-2.86) or a cisgender woman (OR 1.72, 95% CI 1.24-2.39) were associated with needing help. In multivariable analyses, requiring assistance was associated with needing frequent help preparing drugs (adjusted OR [AOR] 9.52, 95% CI 4.78-21.28), fewer years since first injection (AOR for 1 year increase: 0.97, 95% CI 0.95-0.99) and injecting stimulants. Among those who required help, cisgender women reported needing assistance more often than cisgender men (P = 0.009).

Discussion and conclusions: Over two-fifths of the sample required help injecting; requiring assistance was associated with sociodemographic indicators and substance use-specific patterns. Findings highlight the need to scale-up educational resources for those who receive or provide help injecting, as well as SCS that accommodate onsite injection assistance.

Keywords: cohort studies; injection assistance; people who inject drugs; supervised consumption services.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Canada
Cross-Sectional Studies
Drug Users*
Female
Harm Reduction
Humans
Male
Substance Abuse, Intravenous* / complications
Substance Abuse, Intravenous* / epidemiology

Grants and funding

PJT-153152/CIHR/Canada