Factors associated with initiating someone into illicit drug injection

Abstract

Aims Most people who inject drugs (PWID) were first initiated into injection by a current PWID. Few studies have examined PWID who assist others into drug injection. Our goal is to describe the prevalence of and risk factors for initiating someone into injection in the last 12 months. Methods We recruited a cross-sectional sample of PWID (N=605) in California from 2011 to 2013. We examined bivariate and multivariate risk factors for initiating someone into injection with a focus on behaviors that might encourage injection initiation such as injecting in front of non-PWID, describing how to inject to non-PWID, and willingness to initiate someone into drug injection. Results Having initiated someone into injection was reported by 34% of PWID overall and 7% in the last 12 months. Forty-four PWID had assisted 431 people into injection in the past year. Factors independently associated with initiating someone into injection in the last 12 months were having injected any person in past month – referred to as being a street doctor‟ -- (Adjusted Odds Ratio [AOR]=3.49; 95% confidence interval [CI]=1.72, 7.08), having described how to inject to non-injectors (2.76; 95% CI=1.28, 5.93), self-reported likelihood of initiating someone in the future (AOR=6.37; 95% CI=3.12, 13.01), and non-injection powder cocaine use in past month (AOR=4.40; 95% CI= 1.90, 10.19). Conclusion Active PWID are important in facilitating the process of drug injection uptake. Interventions to reduce initiation should include efforts to change behaviors and intentions among PWID that are associated with injection uptake among others.

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

“…There is a substantial literature on gender and injection initiation with many studies (Eaves, 2004; Roy et al, 2010; Simmons et al, 2012; Stenbacka, 1990), but not all (Bryant and Treloar, 2007; Doherty et al, 2000), finding that men are more likely to initiate non-injectors as compared to women. In our own analysis of initiating non-injectors in the last 12 months, we found that men were no more likely to initiate a non-injector than women (Bluthenthal et al, 2014). This finding is consistent with other studies about initiation that have not found this behavior to be associated with gender (Bryant and Treloar, 2008; Rotondi et al, 2014; Strike et al, 2014).…”

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

“…And lastly, quantitative studies have found that established PWID who describe injection to non-injectors and speak positively about injection to non-injectors are more likely to report past and recent initiation of injection-naïve drug users into drug injection. (Bluthenthal et al, 2014; Rotondi et al, 2014; Strike et al, 2014). …”

The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis

“…Quantitative studies of injection drug use initiation have explored a range of factors linked to injection initiation, including shifts in the drug supply, drugs used, unemployment, family disruption, homelessness, incarceration and social networks (12–19). Whilst quantitative studies can detect relationships between individual, social and structural factors and injection initiation, they are less appropriate for addressing the ‘why’ questions underpinning these relationships.…”

Preventing Injection Drug use Initiation: State of the Evidence and Opportunities for the Future

“…Instead, the research to date suggests that exposure to injecting and initiation may be associated in multiple ways: injection-naive persons may observe injection or hear PWID speak positively about it [19,24,37]; PWID may act as sources of injection education [19,28]; and PWID may also directly assist individuals with injection during their initiation events [39,45].…”