Lianping Ti1, Lindsey Richardson2, Kora DeBeck3, Paul Nguyen2, Julio Montaner4, Evan Wood4, Thomas Kerr5. 1. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3. 2. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6. 3. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6. 4. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9. 5. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9. Electronic address: uhri-tk@cfenet.ubc.ca.
Abstract
BACKGROUND: Despite the growing prevalence of illicit stimulant drug use internationally, and the widespread involvement of people who inject drugs (IDU) within street-based drug markets, little is known about the impact of different types of street-based income generation activities on the cessation of stimulant use among IDU. METHODS: Data were derived from an open prospective cohort of IDU in Vancouver, Canada. We used Kaplan-Meier methods and Cox proportional hazards regression to examine the effect of different types of street-based income generation activities (e.g., sex work, drug dealing, and scavenging) on time to cessation of stimulant use. RESULTS: Between December, 2005 and November, 2012, 887 IDU who use stimulant drugs (cocaine, crack cocaine, or crystal methamphetamine) were prospectively followed-up for a median duration of 47 months. In Kaplan-Meier analyses, compared to those who did not engage in street-based income generation activities, participants who reported sex work, drug dealing, scavenging, or more than one of these activities were significantly less likely to report stimulant drug use cessation (all p<0.001). When considered as time-updated variables and adjusted for potential confounders in a multivariable model, each type of street-based income generation activity remained significantly associated with a slower time to stimulant drug cessation (all p<0.005). CONCLUSIONS: Our findings highlight the urgent need for strategies to address stimulant dependence, including novel pharmacotherapies. Also important, structural interventions, such as low-threshold employment opportunities, availability of supportive housing, legal reforms regarding drug use, and evidence-based approaches that reduce harm among IDU are urgently required.
BACKGROUND: Despite the growing prevalence of illicit stimulant drug use internationally, and the widespread involvement of people who inject drugs (IDU) within street-based drug markets, little is known about the impact of different types of street-based income generation activities on the cessation of stimulant use among IDU. METHODS: Data were derived from an open prospective cohort of IDU in Vancouver, Canada. We used Kaplan-Meier methods and Cox proportional hazards regression to examine the effect of different types of street-based income generation activities (e.g., sex work, drug dealing, and scavenging) on time to cessation of stimulant use. RESULTS: Between December, 2005 and November, 2012, 887 IDU who use stimulant drugs (cocaine, crack cocaine, or crystal methamphetamine) were prospectively followed-up for a median duration of 47 months. In Kaplan-Meier analyses, compared to those who did not engage in street-based income generation activities, participants who reported sex work, drug dealing, scavenging, or more than one of these activities were significantly less likely to report stimulant drug use cessation (all p<0.001). When considered as time-updated variables and adjusted for potential confounders in a multivariable model, each type of street-based income generation activity remained significantly associated with a slower time to stimulant drug cessation (all p<0.005). CONCLUSIONS: Our findings highlight the urgent need for strategies to address stimulant dependence, including novel pharmacotherapies. Also important, structural interventions, such as low-threshold employment opportunities, availability of supportive housing, legal reforms regarding drug use, and evidence-based approaches that reduce harm among IDU are urgently required.
Authors: S Minozzi; L Amato; M Davoli; M Farrell; A A R L Lima Reisser; P P Pani; M Silva de Lima; B Soares; S Vecchi Journal: Cochrane Database Syst Rev Date: 2008-04-16
Authors: Paula Braitstein; Kathy Li; Mark Tyndall; Patricia Spittal; Michael V O'Shaughnessy; Arn Schilder; Caitlin Johnston; Robert S Hogg; Martin T Schechter Journal: Soc Sci Med Date: 2003-08 Impact factor: 4.634
Authors: Kaitlyn Jaffe; Huiru Dong; Anna Godefroy; Davin Boutang; Kanna Hayashi; M-J S Milloy; Thomas Kerr; Lindsey Richardson Journal: Int J Drug Policy Date: 2018-08-08
Authors: Nicole M Luongo; Huiru Dong; Thomas H Kerr; M-J S Milloy; Kanna Hayashi; Lindsey A Richardson Journal: Addict Behav Date: 2016-08-31 Impact factor: 3.913
Authors: David Toro-Tobón; Dedsy Berbesi-Fernandez; Pedro Mateu-Gelabert; Ángela M Segura-Cardona; Liliana P Montoya-Vélez Journal: J Subst Use Date: 2017-03-28