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CMAJ • August 21, 2001; 165 (4)
© 2001 Canadian Medical Association or its licensors

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Unsafe injection practices in a cohort of injection drug users in Vancouver: Could safer injecting rooms help?

Evan Wood*{dagger}, Mark W. Tyndall*{dagger}, Patricia M. Spittal*{dagger}, Kathy Li*, Thomas Kerr*, Robert S. Hogg*{dagger}, Julio S.G. Montaner*{dagger}{ddagger}, Michael V. O'Shaughnessy*§ and Martin T. Schechter*{dagger}

From *the British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, and the Departments of {dagger}Health Care and Epidemiology, {ddagger}Medicine and §Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC

Correspondence to: Dr. Martin T. Schechter, Professor and Head, Department of Health Care and Epidemiology, University of British Columbia, 5804 Fairview Ave., Vancouver BC V6T 1Z3; fax 604 822-4994; martin.schechter{at}ubc.ca

Background: In several European countries safer injecting rooms have reduced the public disorder and health-related problems of injection drug use. We explored factors associated with needle-sharing practices that could potentially be alleviated by the availability of safer injecting rooms in Canada.

Methods: The Vancouver Injection Drug User Study is a prospective cohort study of injection drug users (IDUs) that began in 1996. The analyses reported here were restricted to the 776 participants who reported actively injecting drugs in the 6 months before the most recent follow-up visit, during the period January 1999 to October 2000. Needle sharing was defined as either borrowing or lending a used needle in the 6-month period before the interview.

Results: Overall, 214 (27.6%) of the participants reported sharing needles during the 6 months before follow-up; 106 (13.7%) injected drugs in public, and 581 (74.9%) reported injecting alone at least once. Variables independently associated with needle sharing in a multivariate analysis included difficulty getting sterile needles (adjusted odds ratio [OR] 2.7, 95% confidence interval [CI] 1.8–4.1), requiring help to inject drugs (adjusted OR 2.0, 95% CI 1.4–2.8), needle reuse (adjusted OR 1.8, 95% CI 1.3–2.6), frequent cocaine injection (adjusted OR 1.6, 95% CI 1.1–2.3) and frequent heroin injection (adjusted OR 1.5, 95% CI 1.04–2.1). Conversely, HIV-positive participants were less likely to share needles (adjusted OR 0.5, 95% CI 0.4–0.8), although 20.2% of the HIV-positive IDUs still reported sharing needles.

Interpretation: Despite the availability of a large needle-exchange program and targeted law enforcement efforts in Vancouver, needle sharing remains an alarmingly common practice in our cohort. We identified a number of risk behaviours — difficulty getting sterile needles, needle sharing and reuse, injection of drugs in public and injecting alone (one of the main contributing causes of overdose) — that may be alleviated by the establishment of supervised safer injecting rooms.




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