Grant: CIHR Fellowship

Across North America, the opioid epidemic continues to escalate with many cities declaring public health emergencies. In this context, preventing, rather than reacting to, the initiation of injection drug use (IDU) is of critical public health importance. Despite prior studies finding that the majority of people who inject drugs (PWID) reported being initiated into IDU by someone who injects drugs, very few interventions have focused on the role of PWID in IDU initiation. Relatedly, very little is known about how periods of institutionalization impact the risk that PWID initiate others into IDU. This is concerning as PWID are frequently institutionalized against their will (child welfare system, compulsory addiction treatment, prison), and there is a high likelihood for population mixing between PWID and injection-naïve individuals during institutionalization. To better understand how and why PWID initiate others into IDU, this study will use advanced epidemiologic research methods to examine how periods of institutionalization influence the likelihood that PWID report providing IDU initiation assistance. It is hypothesized that experiences of institutionalization will increase the risk of PWID reporting initiating others into IDU and that sociodemographic, drug-related and other broader factors (e.g., housing, access to opioid substitution therapy [buprenorphine]) will modify (either increase or decrease) this risk. These hypotheses will be tested using data from three observational cohort studies of PWID in Vancouver, Canada, San Diego, USA and Tijuana, Mexico. This study will be the first to investigate the likelihood of initiating others into IDU during periods of institutionalization and to compare health and drug use outcomes among diverse populations across North America. It is hoped that the findings will inform IDU prevention efforts and programming for child welfare systems, correctional facilities and addiction treatment facilities in Canada and abroad.