High-Intensity Drug Use and Health Service Access Among Street-Involved Youth in a Canadian Setting

Abstract

Background/ Objectives Addiction severity has been associated with numerous social- and health-related harms. This study sought to examine the prevalence and correlates of high intensity drug use among street-involved youth in a Canadian setting with a focus on high-risk drug use practices and health service access. Methods Data were derived from the At-Risk Youth Study (ARYS), a Vancouver-based prospective cohort of street-involved youth aged 14-26. We used generalized estimating equations (GEE) to examine variables associated with high intensity drug use, defined as daily use of crack cocaine, cocaine, heroin or crystal methamphetamine. Results From September 2005 to November 2012, of 1017 youth included in the analyses, 529 (52%) reported high intensity drug use as defined above at least once during the study period. In a multivariate analysis, older age (Adjusted Odds Ratio [AOR] = 1.47); residing in the Downtown Eastside of Vancouver (AOR=1.46); homelessness (AOR=1.30); recent incarceration (AOR=1.25); inability to access addiction treatment (AOR=1.42); and crack pipe sharing and/or used syringe injecting (AOR=2.64), were all positively and independently associated with high intensity drug use (p<0.05). The most common barrier to accessing addiction treatment reported by these youth was long waiting lists. Conclusions High intensity drug use among street-involved youth was prevalent and associated with structural and geographical disadvantages in addition to high-risk drug administration practices. Youth reporting more frequent drug use also reported barriers to accessing addiction treatment, highlighting the need to expand addiction services tailored to youth at greatest risk of harm from illicit drug use and street-involvement.

Still “at risk”: An examination of how street-involved young people understand, experience, and engage with “harm reduction” in Vancouver’s inner city

“…However, young peoples’ description of cannabis use as a strategy for self-detoxification may also reflect their difficulty gaining access to addiction treatment (Phillips et al, 2014; Phillips et al, 2015), including medically supervised detoxification. This was also evident in our findings.…”

Structural factors associated with methamphetamine smoking among female sex workers in Tijuana, Mexico

“…We found that FSWs who experienced a period of homelessness, but still maintained a good financial situation, were more likely to smoke methamphetamine daily. Others have found a similar link between frequency of drug use and homelessness . The proposed mechanism behind the counterintuitive modifier of income is that higher income women may be prioritising the purchase of methamphetamine over securing housing .…”

Street-involved youth engaged in sex work at increased risk of syringe sharing

“…Increased addiction severity may result in more frequent drug administration leading to both more opportunities to use unsterile syringes, and increased need for means to pay for drugs. Reasons young people have difficulty seeking addiction treatment are numerous, and include perceived and real discrimination from healthcare workers, fear of being reported to police or child protection authorities, and organizational barriers such as requiring a fixed address (Barker, Kerr, Nguyen, Wood, & DeBeck, 2015; Haley & Roy, 1999; Phillips et al, 2014; Phillips et al, 2015). Efforts to increase access to addiction treatment, particularly that is trauma-informed, should be a priority.…”