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

Abstract

BackgroundUrban drug scenes are characterized by high prevalence of illicit drug dealing and use, violence and poverty, much of which is driven by the criminalization of people who use illicit drugs (PWUD) and the associated stigma. Despite significant public health needs, little is understood about patterns of moving into urban drug scenes among PWUD. Therefore, we sought to identify trajectories of residential mobility (hereafter ‘mobility’) among PWUD into the Downtown Eastside (DTES), an urban neighbourhood with an open drug scene in Vancouver, Canada, as well as characterize distinct trajectory groups among PWUD.MethodsData were derived from three prospective cohort studies of community-recruited PWUD in Vancouver between 2005 and 2016. We used latent class growth analysis (LCGA) to identify distinct patterns of moving into the DTES among participants residing outside of DTES at baseline. Multivariable multinomial logistic regression was used to determine baseline factors associated with each trajectory group.ResultsIn total, 906 eligible participants (30.9% females) provided 9,317 observations. The LCGA assigned four trajectories: consistently living outside of DTES (52.8%); early move into DTES (11.9%); gradual move into DTES (19.5%); and move in then out (15.8%). Younger PWUD, those of Indigenous ancestry, those who were homeless or living in a single-room occupancy hotel (SRO), and those injecting drugs daily were more likely to move in then out of DTES (all p<0.05). Living in an SRO, daily injection drug use, and recent incarceration were also positively associated with early mobility (all p<0.05).ConclusionsNearly half of the participants moved into the DTES. Younger PWUD and Indigenous peoples appeared to have particularly high mobility, as did those with markers of social-structural vulnerability and high intensity drug use. These findings indicate a need to tailor existing social and health services within the DTES and expand affordable housing options outside the DTES.

Using synthetic controls to estimate the population-level effects of Ontario’s recently implemented overdose prevention sites and consumption and treatment services

“…Until recently, all the evidence on the effectiveness of supervised consumption sites in Canada was based on Vancouver’s Insite. First implemented in September 2003, Insite is in the Downtown Eastside – a unique neighborhood with one of the highest concentrations of people who use illicit drugs globally (Hayashi et al, 2019). Numerous studies have explored Insite’s effectiveness on drug related harms and acceptability in the community.…”

Indicators of Drug-Related Community Impacts of Open Drug Scenes: A Scoping Review

“…Some identified indicators in the current study partly overlapped with indicators that have been previously reported by the EMCDDA and Pompidou group. Some DRCI indicators are not presented in the current study including poverty, street homelessness, the emergence of crack houses, attraction of new people to drug scene, and mental illness [2,4,47]. However, some indicators including street dealing, crime, discarded injecting equipment, and intimidation of citizens were common in previous reports and current studies [2,4,47].…”

“…Some DRCI indicators are not presented in the current study including poverty, street homelessness, the emergence of crack houses, attraction of new people to drug scene, and mental illness [2,4,47]. However, some indicators including street dealing, crime, discarded injecting equipment, and intimidation of citizens were common in previous reports and current studies [2,4,47]. Therefore, for arranging the indicators, they can potentially be categorized into direct and indirect indicators of DRCIs.…”

“…The major features of ODSs including drug dealing and/or taking in public, are examples of direct indicators of DRCIs [1]. Some PWUDs reside around/in the drug scenes due to the availability of the drug dealers [47], whereas some others move to these areas to purchase drugs [47,49]. Some PWUDs may consume drugs in/ around the scene due to strong craving or few alternative (and/or safe) places to use drugs, such as SIFs [28,[50][51][52].…”

GRAND PLAN: Safety and Efficacy of Glecaprevir/Pibrentasvir for the Treatment of Hepatitis C Virus Infection Among People Initially Disengaged From Health Care Who Use Drugs—A Systematic Multidisciplinary Approach

“…Furthermore, it is worth noting that >20% of the study population identified as Indigenous. In British Columbia and all of Canada, men and women of Indigenous descent are overrepresented in our inner cities and more likely to be disengaged from care [ 25 , 26 ]. It is a strength of our overall approach that we were able to identify, treat, and cure these patients.…”