Introduction
Although the health and community benefits of supervised injection facilities are
well documented, little is known about long-term patterns of utilization of this form
of health service. The present study seeks to longitudinally characterize discontinuation
of use of a supervised injection facility in Vancouver, Canada.
Methods
Data were drawn from 2 community-recruited prospective cohorts of people who inject
drugs between December 2005 and December 2016. In 2018, extended Cox regression for
recurrent events was used to examine factors associated with time to cessation of
supervised injection facility use during periods of active injection.
Results
Of 1,336 people who inject drugs that were followed for a median of 50 months, 847
(63.4%) participants reported 1,663 6-month periods of supervised injection facility
use cessation while actively injecting drugs (incidence density of 26.6 events per
100 person-years). An additional 2,282 (57.8%) of the total 3,945 6-month periods
of supervised injection facility use cessation occurred during periods of injection
cessation. In multivariable analyses, enrollment in methadone maintenance therapy
(adjusted hazard ratio=1.41) and HIV seropositivity (adjusted hazard ratio=1.23) were
positively associated with supervised injection facility use cessation during periods
of active injection, whereas homelessness (adjusted hazard ratio=0.59), at least daily
heroin injection (adjusted hazard ratio=0.70), binge injection (adjusted hazard ratio=0.68),
public injection (adjusted hazard ratio=0.67), nonfatal overdose (adjusted hazard
ratio=0.73), difficulty accessing addiction treatment (adjusted hazard ratio=0.69),
and incarceration (adjusted hazard ratio=0.70) were inversely associated with this
outcome (all p<0.05). The most commonly reported reasons for supervised injection facility use cessation
were injection drug use cessation (42.3%) and a preference for injecting at home (30.7%).
Conclusions
These findings suggest that this supervised injection facility successfully retains
people who inject drugs at elevated risk of drug-related harms and indicate that many
supervised injection facility clients neither use this service nor inject drugs perpetually.
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Article info
Publication history
Published online: August 01, 2019
Identification
Copyright
© 2019 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
