Format

Send to

Choose Destination
Drug Alcohol Depend. 2019 Apr 1;197:354-360. doi: 10.1016/j.drugalcdep.2018.12.018. Epub 2019 Jan 22.

Opioid agonist treatment and the process of injection drug use initiation.

Author information

1
Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA; School of Medicine, Universidad Xochicalco, Tijuana, Mexico.
2
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.
3
BC Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.
4
BC Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
5
Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA; Department of Pediatrics and Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.
6
Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA. Electronic address: dwerb@ucsd.edu.

Abstract

BACKGROUND:

Opioid agonist treatment (OAT) is an effective biomedical intervention to manage opioid use disorder among persons who inject drugs (PWID). Preliminary evidence suggests that OAT may also disrupt the social communicability of injection drug use (IDU) practices by established PWID. We therefore aim to investigate the association between OAT enrollment and initiating others into IDU among PWID in Vancouver, Canada.

METHODS:

Preventing Injecting by Modifying Existing Responses (PRIMER; NIDA DP2-DA040256-01) is a prospective multi-cohort study seeking to identify structural interventions that reduce the risk that PWID initiate others into IDU. The present analysis was conducted using data from a participating cohort of PWID in Vancouver, Canada, between December 2014 and May 2017. Multivariable logistic regression models were built to assess the association between reporting active (i.e., within the past six months) OAT enrollment and assisting others in injection initiation. A final model was determined using a manual stepwise approach whereby covariates were excluded if their removal altered the coefficient of interest by <5%.

RESULTS:

Participants (n = 1740) were predominantly male (62.3%); 35.1% reported daily injecting (n = 611); 860 (49.4%) reported active OAT enrollment, and 80 (4.6%) reported recently providing injection initiation assistance. In a multivariable model, participants who reported active OAT enrollment had significantly lower odds of recently providing injection initiation assistance (Adjusted Odds Ratio = 0.52, 95% Confidence Interval: 0.31-0.87, P = 0.01).

CONCLUSION:

Results suggest a protective association between OAT and the expansion of IDU practices among vulnerable populations, suggesting its potential use as 'addiction treatment as prevention.'

KEYWORDS:

HCV prevention; HIV prevention; Methadone; Opioid agonist treatment; Overdose prevention; Persons who inject drugs; Suboxone; Treatment as prevention

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center