It is estimated that approximately 340,000 Americans and 100,000 Canadians are injection drug users (IDUs). Injection drug use can lead to overdose death, infectious disease spread, loss of social and economic functioning, and extensive engagement in criminal activity. For these reasons, interventions that may affect the natural history of injecton drug use, and in turn reduce these consequences, are of international interest. This study proposes to: determine the incidence of initiation into injection drug use among high-risk non-injection drug using youth and to elucidate individual, cultural, and environmental risk factors for initiation of injection; to evaluate the natural history of injection drug use from initiation to cessation or death, and to examine how specific environmental factors and interventions, such as prevention programs or addiction treatment interventions, can influence this natural history; to determine individual, cultural, and environmental barriers to the use of secondary prevention services, addiction treatment, and medical care; and to evaluate how trends in service use affect the incidence of HIV and associated risk behaviors as well as rates of mortality among a cohort of active IDUs. Vancouver is ideally suited to the proposed research questions for several reasons. First, the incidence of initiation into injection drug use among high-risk youth in our setting remains high. Second, the city is home to ongoing high rates of overdose mortality and HIV incidence among active IDUs. Second, British Columbia has a province-wide, centralized program of free access to highly active antiretroviral therapy (HAART), and a universal healthcare system that provides all medical care, including addiction treatment, free of charge. Understanding the mechanisms and interventions that affect the natural history of injection drug use, and the incidence of the consequences of injection drug use, are critical questions in North America. As such, this project will help inform prevention strategies and interventions throughout North America and elsewhere.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
Project #
Application #
Study Section
AIDS Clinical Studies and Epidemiology Study Section (ACE)
Program Officer
Lambert, Elizabeth
Project Start
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University of British Columbia
Zip Code
V6 1-Z3
Damon, Will; Small, Will; Anderson, Solanna et al. (2017) 'Crisis' and 'everyday' initiators: A qualitative study of coercion and agency in the context of methadone maintenance treatment initiation. Drug Alcohol Rev 36:253-260
Luongo, Nicole M; Dong, Huiru; Kerr, Thomas H et al. (2017) Income generation and attitudes towards addiction treatment among people who use illicit drugs in a Canadian setting. Addict Behav 64:159-164
Krüsi, Andrea; McNeil, Ryan; Moore, David et al. (2017) 'Because I've been extremely careful': HIV seroconversion, responsibility, citizenship and the neo-liberal drug-using subject. Health Risk Soc 19:58-73
Poon, Art F Y; Gustafson, Réka; Daly, Patricia et al. (2016) Near real-time monitoring of HIV transmission hotspots from routine HIV genotyping: an implementation case study. Lancet HIV 3:e231-8
Jacka, Brendan; Applegate, Tanya; Poon, Art F et al. (2016) Transmission of hepatitis C virus infection among younger and older people who inject drugs in Vancouver, Canada. J Hepatol 64:1247-55
Kennedy, Mary Clare; Milloy, M-J; Markwick, Nicole et al. (2016) Encounters with private security guards among people who inject drugs in a Canadian setting. Int J Drug Policy 28:124-7
Tucker, Devin; Hayashi, Kanna; Milloy, M-J et al. (2016) Risk factors associated with benzodiazepine use among people who inject drugs in an urban Canadian setting. Addict Behav 52:103-7
Luchenski, Serena; Ti, Lianping; Hayashi, Kanna et al. (2016) Protective factors associated with short-term cessation of injection drug use among a Canadian cohort of people who inject drugs. Drug Alcohol Rev 35:620-7
Lyons, Tara; Shannon, Kate; Richardson, Lindsey et al. (2016) Women Who Use Drugs and Have Sex with Women in a Canadian Setting: Barriers to Treatment Enrollment and Exposure to Violence and Homelessness. Arch Sex Behav 45:1403-10
Fairbairn, Nadia; Hayashi, Kanna; Milloy, M-J et al. (2016) Hazardous Alcohol Use Associated with Increased Sexual Risk Behaviors Among People Who Inject Drugs. Alcohol Clin Exp Res 40:2394-2400

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