“Getting out of downtown”: a longitudinal study of how street-entrenched youth attempt to exit an inner city drug scene

Abstract

BackgroundUrban drug “scenes” have been identified as important risk environments that shape the health of street-entrenched youth. New knowledge is needed to inform policy and programing interventions to help reduce youths’ drug scene involvement and related health risks. The aim of this study was to identify how young people envisioned exiting a local, inner-city drug scene in Vancouver, Canada, as well as the individual, social and structural factors that shaped their experiences.MethodsBetween 2008 and 2016, we draw on 150 semi-structured interviews with 75 street-entrenched youth. We also draw on data generated through ethnographic fieldwork conducted with a subgroup of 25 of these youth between.ResultsYouth described that, in order to successfully exit Vancouver’s inner city drug scene, they would need to: (a) secure legitimate employment and/or obtain education or occupational training; (b) distance themselves – both physically and socially – from the urban drug scene; and (c) reduce their drug consumption. As youth attempted to leave the scene, most experienced substantial social and structural barriers (e.g., cycling in and out of jail, the need to access services that are centralized within a place that they are trying to avoid), in addition to managing complex individual health issues (e.g., substance dependence). Factors that increased youth’s capacity to successfully exit the drug scene included access to various forms of social and cultural capital operating outside of the scene, including supportive networks of friends and/or family, as well as engagement with addiction treatment services (e.g., low-threshold access to methadone) to support cessation or reduction of harmful forms of drug consumption.ConclusionsPolicies and programming interventions that can facilitate young people’s efforts to reduce engagement with Vancouver’s inner-city drug scene are critically needed, including meaningful educational and/or occupational training opportunities, ‘low threshold’ addiction treatment services, as well as access to supportive housing outside of the scene.

Moving into an urban drug scene among people who use drugs in Vancouver, Canada: Latent class growth analysis

“…Younger PWUD were more likely to gradually move into the DTES or move in then out of DTES. Our findings are in line with previous ethnographic studies describing that young PWUD in Vancouver symbolically associate the DTES neighborhood with danger and try to avoid visiting or seek to exit the neighborhood once having moved in [12,13]. This is in contrast to a commonly held claim that urban drug scenes attract youth [2].…”

“…After the LCGA was completed, we considered a range of explanatory variables that we hypothesized might predict mobility trajectory group memberships as identified from the LCGA. The selection of the variables was informed by previous research on mobility of PWUD [10,12,13], input from the VCH Aboriginal Health team and observational experiences of healthcare providers within and outside of the DTES (co-authors AD, RJ and RB). All explanatory variables were assessed at baseline, referred to the past six months, and were dichotomized as yes vs .…”

“…PWUD are known to have high residential mobility (hereafter ‘mobility’), which has been shown to be associated with poor health outcomes such as HIV infection [10,11]. Previous research has suggested that there are likely many competing “push-pull” factors that influence PWUD’s decision to move, including access to drugs, poverty, employment, safety, previous involvement in the criminal justice system, and enrolment in addiction treatment programs [10,12,13]. While these diverse factors have been explored primarily through qualitative and ethnographic research, few quantitative studies have attempted to identify and characterize common patterns of moving into urban drug scenes among PWUD.…”

“…This approach has largely neglected PWUD’s experiences of social and economic sufferings that may have driven their problematic drug use, and has likely served to compound high mobility among this population [8]. While some qualitative and ethnographic studies have explored how social, structural and geographical factors interact with individual drug use and shape PWUD’s mobility [12,13], these research findings have not been corroborated by larger quantitative studies, likely due to the difficulty obtaining longitudinal mobility data from PWUD. In this regard, our study is uniquely positioned to contribute rare quantitative evidence to advance theories regarding factors associated with mobility patterns among PWUD [10,12,13].…”

“…While some qualitative and ethnographic studies have explored how social, structural and geographical factors interact with individual drug use and shape PWUD’s mobility [12,13], these research findings have not been corroborated by larger quantitative studies, likely due to the difficulty obtaining longitudinal mobility data from PWUD. In this regard, our study is uniquely positioned to contribute rare quantitative evidence to advance theories regarding factors associated with mobility patterns among PWUD [10,12,13]. Also, given that many of the health services targeted for PWUD requires continuum of care (e.g., opioid agonist maintenance therapy), an empirical examination of mobility patterns among PWUD such as this is important to inform more effective provision of health and social services among this population, which has long taken a back seat behind the law enforcement-based policy approach to illicit drug use [19].…”