Characteristics of people who initiate injection drug use later in life

Abstract

BACKGROUND Studies report that among people who inject drugs (PWID), approximately 1 in 7 initiated injection during their thirties or later (referred to hereafter as “late initiates”). However, little is known about individuals who are late initiates. This study aims to describe characteristics of late initiates to drug injection and to examine how they differ from people who initiated drug injection prior to the age of 30 (“typical initiates”). METHODS We recruited 696 active PWID in Los Angeles and San Francisco, California between 2011 and 2013, using targeted sampling and street outreach methods. Participants completed personal interviews that covered items on demographics, drug use history and practices, injection initiation episode, HIV injection- and sex-related risk, health care utilization among others. We used bivariate and multivariate analyses to examine factors associated being a late initiate. RESULTS In our sample, 19% of participants who were 30 years or older were classified as late initiates. In multivariate analysis controlling for city, late initiates had higher odds of being female and African American, having been in treatment prior to initiation, initiating illicit drug use at an older age, and being assisted into injection by someone of the same age or younger. Late initiates had lower odds of frequent recent injection, and having a bipolar disorder diagnosis. CONCLUSION Late initiates comprise a significant proportion of active PWIDs. More study on the health consequences of late initiation are needed as are interventions to prevent transition to drug injection among at-risk populations.

Human immunodeficiency virus prevalence and risk determinants among people who inject drugs in the Republic of Georgia

“…Published evidence suggests drug injection initiation at older age is associated with safer behavior [33,34] but our analysis shows that PWID who started injection at later age, are more at risk of HIV infection. This phenomenon is difficult to explain and requires further research.…”

Drug use generations and patterns of injection drug use: Birth cohort differences among people who inject drugs in Los Angeles and San Francisco, California

“…The exceptionally strong absolute beta effect on TTII of “any drug treatment prior to first injection” in our multivariate analysis, suggests that increasing access to substance abuse treatment--especially for opiate prescription and heroin users (Jones et al, 2015a)--might be a cost-effective public health priority (see also (Cicero et al, 2012; Dart et al, 2015b). Other potential upstream public health approaches to preventing transitions to injection that might have longer-term population cohort level effects might include 1) interventions to prevent nonmedical use of prescription opioids, (Cicero et al, 2012; Dart et al, 2015b)--including controls on pharmaceutical advertising to physicians;(Netherland and Hansen, 2016) 2) culturally competent and generationally targeted interventions to prevent injection initiation among youth who use drugs through non-injection routes of administration, (Des Jarlais et al, 1992; Werb et al, 2013) with a focus on other drugs like methamphetamine and vulnerable populations as well, and 3) working with established PWID to reduce behaviors that facilitate injection initiation among people who are naïve to injection (Arreola et al, 2014; Bluthenthal and Kral, 2015; Bluthenthal et al, 2015; Stillwell et al, 1999; Strike et al, 2014). …”

“…Participants received $15USD for completing the survey. Study methods have been described in greater detail elsewhere (Arreola et al, 2014; Wenger et al, 2016). Our analytic sample consisted of 776 participants for whom we had complete data on age at first drug use and first injection.…”

Factors associated with being asked to initiate someone into injection drug use

“…These measures are described in greater detail elsewhere (Arreola et al, 2014; Bluthenthal et al, 2014; Quinn et al, 2014). …”