The Association Between Problematic Alcohol Consumption, Other Risk Behaviours and Health Outcomes Among People Who Inject Drugs, 2017-2019

Author: Eva Emanuel Ayeshat Ibitoye Sara Croxford Claire Edmundson Lucinda Slater Jacquelyn Njoroge Monica Desai

Theme: Epidemiology & Public Health Research Year: 2022

People who inject drugs (PWID) face structural and social barriers limiting their engagement with
health services, and untreated alcohol dependency is often overlooked. We examined the
association between high-risk alcohol consumption, other risk behaviours and health outcomes
among people reporting injecting in the last year.
The Unlinked Anonymous Monitoring Survey is a cross-sectional bio-behavioural survey of PWID in
England, Wales, and Northern Ireland. Between 2017-2019, an alcohol risk score was generated
based on the “AUDIT-C” tool: (1) Alcohol consumption frequency, (2) Units consumed on a typical
drinking day, and (3) Frequency of consuming ≥6 (women) or ≥8 (men) units in the last year. Scores
of 0 indicate never consuming alcohol, 1-3 (men)/1-4 (women) indicates low-risk consumption; >3
(men)/>4 (women) indicates high-risk consumption. PWID who reported never consuming alcohol
and/or not injecting in the last year were excluded. Here we measured the association between
high-risk alcohol consumption, other behaviours and health outcomes using logistic regression
adjusting for survey year, age, sex and region of recruitment.
During 2017-2019, 72% (2,174/3,012) of PWID reported high-risk alcohol consumption. High-risk
alcohol consumption was associated with other risky behaviours including: crack (adjusted odds
ratio: 1.58, 95% confidence interval: 1.29-1.93) and/or powder cocaine (1.44; 1.07-1.92) injection in
the last month, sexualised drug use (1.47; 1.11-1.96) and/or multiple sexual partners (1.71; 1.32-
2.22) in the last year, and sharing needles or syringes in the last month (1.45; 1.13-1.87). PWID
reporting high-risk alcohol consumption had greater odds of reporting homelessness in the last year
(1.28; 1.06-1.55), ever imprisonment (1.32; 1.12-1.59), being hepatitis C antibody-positive (1.28;
1.08-1.53), and overdosing in the last year (1.80; 1.44-2.23).
Problematic alcohol consumption is common among PWID and is associated with adverse health
outcomes, such as HCV infection and non-fatal overdose. Interventions must address overlapping
risk behaviours in PWID.
Disclosure of Interest Statement: 
There are no conflicts of interest.

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