Trajectories of injection drug use among people who use drugs in Vancouver, Canada, 1996–2017: growth mixture modeling using data from prospective cohort studies

Abstract

Background and aims Injection drug use patterns are known to change over time, although such long‐term changes have not been well described. We sought to characterize longitudinal trajectories of injection drug use and identify associated factors. Design Data were derived from the Vancouver Injection Drug Users Study and AIDS Care Cohort to evaluate the Exposure to Survival Services study, two prospective cohorts involving people who inject drugs in Vancouver, Canada between 1996 and 2017. Growth mixture modeling was applied to identify distinct injection drug use trajectories. Multinomial logistic regression was used to identify baseline factors associated with each trajectory. Setting Canada. Participants A total of 2057 participants who reported having used illicit drugs via injection in the past 6 months at the baseline visit were included in the study. The median time since first injection drug use at baseline was 14.8 years (quartile 1–quartile 3: 6.5–24.3). Measurements Information regarding self‐reported injection drug use during the past 6 months was collected at baseline and semi‐annually thereafter via interviewer‐administered questionnaires. Findings Participants were followed for a median of 113.4 months (quartile 1–quartile 3: 63.4–161.7). Five trajectories were identified: persistent high frequency injection (507, 24.6%); high frequency injection with late decrease (374, 18.2%); gradual cessation (662, 32.2%); early cessation with late relapse (227, 11.0%); and early cessation (287, 14.0%). Factors found to be associated with distinct trajectories included: daily heroin injection, binge injection drug use, age, not being in a stable relationship and year of study enrollment. Conclusions People who used drugs in Vancouver, Canada from 1996 to 2017 appeared to follow five drug use trajectories, ranging from persistent high frequency use to early cessation. Almost 25% of participants remained high‐frequency injectors over the study period.

High rates of resumption of injecting drug use following release from prison among men who injected drugs before imprisonment

“…Previous studies of post‐release IDU reported no association with age [17, 18]. Studies of community‐recruited people who inject drugs have reported inconsistent findings, with findings showing both increased [27–29] and decreased [30] rates of IDU cessation among younger adults and reduced risk of IDU resumption following cessation among older people [31]. Our results of reduced odds of resumption for younger participants, but also incrementally lower odds as participants age beyond 39 years, offer insights that potentially bridge these paradoxical findings.…”

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