Potential use of supervised injection services among people who inject drugs in a remote and mid-size Canadian setting

Abstract

Background While supervised injection services (SIS) feasibility research has been conducted in large urban centres across North America, it is unknown whether these services are acceptable among people who inject drugs (PWID) in remote, mid-size cities. We assessed willingness to use SIS and expected frequency of SIS use among PWID in Thunder Bay, a community in Northwestern, Ontario, Canada, serving people from suburban, rural and remote areas of the region. Methods Between June and October 2016, peer research associates administered surveys to PWID. Sociodemographic characteristics, drug use and behavioural patterns associated with willingness to use SIS and expected frequency of SIS use were estimated using bivariable and multivariable logistic regression models. Design preferences and amenities identified as important to provide alongside SIS were assessed descriptively. Results Among 200 PWID (median age, IQR: 35, 28–43; 43% female), 137 (69%) reported willingness to use SIS. In multivariable analyses, public injecting was positively associated with willingness to use (Adjusted Odds Ratio (AOR): 4.15; 95% confidence interval (CI): 2.08–8.29). Among those willing to use SIS, 87 (64%) said they would always/usually use SIS, while 48 (36%) said they would sometime/occasionally use SIS. In multivariable analyses, being female (AOR: 2.44; 95% CI: 1.06–5.65) and reporting injecting alone was positively associated with higher expected frequency of use (AOR: 2.59; 95% CI: 1.02–6.58). Conclusions Our findings suggest that SIS could play a role in addressing the harms of injection drug use in remote and mid-sized settings particularly for those who inject in public, as well as women and those who inject alone, who report higher expected frequency of SIS use. Design preferences of local PWID, in addition to differences according to gender should be taken into consideration to maximize the uptake of SIS, alongside existing health and social service provisions available to PWID.

Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study

“…With overdose deaths rates in BC recently increasing during the COVID-19 pandemic ( British Columbia Coroners Service, 2020 ), and recent reports showing an increase in overdose events ( British Columbia Centre for Disease Control, 2020 ) our study highlights the public health imperative for safe supply program development and expansion. Our findings build on previous research demonstrating the demand for, and uptake of, safe environment interventions designed to address issues associated with the intersection of drug use and structural vulnerability ( McNeil et al, 2015 ; McNeil and Small, 2014 ; Mitra et al, 2019 ).…”

Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in Northern Ontario, Canada

“…Notably, there have been a number of low-threshold harm reduction-based interventions implemented in some of these communities since our data was collected. For example, supervised consumption and/or overdose prevention sites (both legally sanctioned and non-legally sanctioned) as well as rapid access addiction medicine clinics (i.e., low-barrier, walk-in clinics where patients can go to get help for a substance use disorder without referrals) have been executed in a number of Northern Ontario communities such as Thunder Bay and Sudbury [67–72].…”

Factors associated with drug checking service utilization among people who use drugs in a Canadian setting

“…We considered a range of explanatory variables, including demographic, behavioral, and other socio-structural characteristics, that might be associated with DCS utilization, based on known correlates of accessing other harm reduction services among this population [2,[24][25][26][27]. Socio-demographic data included: self-identified gender (male vs. non-male); age (per year older); homelessness (yes vs. no); ethnicity/ancestry (white vs. non-white); and living in the Downtown Eastside neighborhood (DTES) of Vancouver that is an epicenter of illicit drug use (yes vs. no).…”

“…1 British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, Canada. 2 Faculty of Health Sciences, Simon Fraser University, 8888…”

“…An opioid overdose crisis continues to impact communities across the United States and Canada. This is attributed in large part to the introduction of potent and illegally manufactured synthetic opioids into the illicit drug supply [1][2][3][4]. In 2018, there were 21.7 opioid overdose deaths per 100,000 population in the United States (US) and 12.4 deaths per 100,000 population in Canada [5,6].…”