Drug Market Variations and Drug Use Practices among People Who Inject Drugs in the Province of Québec, Canada

Author: Roy É, Leclerc P, Morissette C, Blanchette C, Blouin K, Arruda N, Parent R, Alary M

Theme: Epidemiology & Public Health Research Year: 2016


Roy É1, Leclerc P3, Morissette C3, Blanchette C4, Blouin K2, Arruda N1, Parent R2, Alary M4

1Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada; 2Institut national de santé publique du Québec, Montréal, QC, Canada; 3Direction de la santé publique du CIUSSS du Centre-Est-de-l’Île-de-Montréal, Montréal, QC, Canada; 4 Centre de recherche du CHU de Québec – Université Laval, Québec, Canada.

Background: Until 2003, people who inject drugs (PWID) in Québec were injecting mainly powder cocaine and heroin. The drug market has significantly diversified since then, with increasing availability of crack and of prescription opioids (PO). This could have led to changes in drug use practices among PWID. The objectives were to examine annual trends in injection of different drugs, crack smoking and frequent injection (FI), and to examine relationships between main drug injected and FI among PWID.

Methods: PWIDs are participants of the Québec ongoing SurvUDI surveillance system. PWID (past 6 months) are recruited in 3 urban and 4 semi-urban/rural sites, mainly in harm reduction programs. Each visit includes a structured interview addressing drug use behaviours. Analyses were carried out using GEE methods. For trend analyses (2003-2014; N=9,382) on drugs and FI (number of injections ≥ upper quartile, previous month), the first interview was selected for PWIDs with multiple participations per year. Analyses on the association between FI and main drug injected were based on all interviews (2011-2015; N=2,801).

Results: Both cocaine and heroin injection significantly declined, with prevalence ratios (PR) per year of 0.982 [95% confidence interval (CI): 0.979-0.985] and 0.977 (95%CI:0.967-0.988), while PO injection [1.052 (1.045-1.059)], crack smoking [1.006 (1.001-1.012)], and FI (≥120 injections, previous month) significantly increased [1.015 (1.004-1.026)]. Compared to PWID who injected mainly cocaine, proportion of PWID reporting FI was higher among those who injected mainly heroin [adjusted PR 1.45; 95%CI: 1.12-1.87] and PO [adjusted PR 2.42 (95%CI: 2.06- 2.86)] adjusting for age, gender, homelessness, income and smoking crack.

Conclusions: Changes in the drug market that have occurred since 2003 are reflected in PWID’s practices. The high frequency of injection observed among PO injectors is of particular concern. Drug market variations are a challenge for health authorities responsible for harm reduction programs.

Disclosure of interest: This work was supported by the Public Health Agency of Canada and the Ministère de la santé et des services sociaux du Québec. None of the authors has commercial relationships that might pose a conflict of interest in connection with this work.

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