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Will Small

Publications and source records attributed to Will Small.

12 recordsLinked to original sources
PubMed2007

Changes in injecting practices associated with the use of a medically supervised safer injection facility.

Injection drug users (IDUs) are vulnerable to serious health complications resulting from unsafe injection practices. We examined whether the use of a supervised safer injection facility (SIF) promoted change in injecting practices among a representative sample of 760 IDUs who use a SIF in Vancouver, Canada. Consistent SIF use was compared with inconsistent use on a number of self-reported changes in injecting practice variables. More consistent SIF use is associated with positive changes in injecting practices, including less reuse of syringes, use of sterile water, swabbing injection sites, cooking/filtering drugs, less rushed injections, safe syringe disposal and less public injecting.

Adult↗
PubMed2006

Public injecting and the need for 'safer environment interventions' in the reduction of drug-related harm.

BACKGROUND: One key structural dimension in the distribution of drug-related harm associated with injecting drug use is the injecting environment. Epidemiological evidence associates elevated blood-borne viral risk with injecting in 'public' and 'semipublic' environments. Yet the quality of evidence on public injecting and related viral risk is variable, and is lacking in many countries such as the United Kingdom. AIM: This commentary considers the micro-injecting environment as a critical dimension of risk, exploring the need for 'safer injecting environment interventions'. METHODS: We draw upon published research evidence and qualitative case examples. RESULTS: We note the limits in epidemiological evidence on public injecting and emphasize the need for ethnographic research to determine the 'social relations' of how drug users and risk practices interact with injecting environments. We identify three main forms of 'safer environment intervention': purpose-built drug consumption rooms; interventions within existing spatial relations; and spatial programming and urban design. While drug consumption rooms find evidence-based support, they are not a panacea. We emphasize the potential of interventions embedded within existing spatial and social relations. These include low-cost pragmatic interventions enhancing facilities and safety at public and semipublic injecting sites and, primarily, peer-based interventions, including peer-supervised injecting sites. We caution against spatial programming and urban design interventions which can cause the displacement of socially marginalized populations and the redistribution of harm. CONCLUSIONS: Public health interventions in the addictions field have in the past focused upon individual behavioural change at the cost of social interventions and environmental change. We wish to focus greater attention on reducing risks related to public injecting and encourage greater debate on 'safer environment interventions' in harm reduction.

Environment↗
PubMed2005

Risk profile of individuals who provide assistance with illicit drug injections.

BACKGROUND: Assisted injection is a common practice among injection drug users (IDU) that carries significant risk for health-related harm. However, little is known about the individuals who provide assistance with injections. METHODS: We evaluated factors associated with providing help injecting among participants enrolled in the Vancouver Injection Drug User Study (VIDUS) using univariate and logistic regression analyses. We also examined self-reported relationships between the provider and the receiver of assisted injection, if compensation was provided for assistance, and what type of compensation was given. RESULTS: Of the 704 IDU eligible for this analysis, 193 (27.4%) had provided help injecting during the last 6 months. Variables independently associated with providing help injecting included: lending one's own syringe (adjusted odds ratio [AOR] = 3.99, p = 0.004); frequent heroin injection (AOR = 3.75, p < 0.001); unstable housing (AOR = 2.15, p < 0.001); binge drug use (AOR = 2.01, p = 0.012); frequent cocaine injection (AOR = 1.95, p = 0.002); and frequent use of crack cocaine (AOR = 1.85, p = 0.002). Help was most often provided to a casual (47.2%) or a close friend (41.5%). Of the 96 (49.7%) individuals who received compensation for providing help, the most common forms of compensation were drugs (89.6%) and money (45.8%). CONCLUSION: Providing help injecting was common among IDU in this cohort and was associated with various high-risk behaviours, including elevated levels of syringe lending. These findings indicate the need for interventions that offset the risks associated with this dangerous practice.

Adult↗
PubMed2005

Do supervised injecting facilities attract higher-risk injection drug users?

BACKGROUND: In Western Europe and elsewhere, medically supervised safer injection facilities (SIFs) are increasingly being implemented for the prevention of health- and community-related harms among injection drug users (IDUs), although few evaluations have been conducted, and there have been questions regarding SIFs' ability to attract high-risk IDUs. We examined whether North America's first SIF was attracting IDUs who were at greatest risk of overdose and blood-borne disease infection. METHODS: We examined data from a community-recruited cohort study of IDUs. The prevalence of SIF use was determined based on questionnaire data obtained after the SIF's opening, and we determined predictors of initiating future SIF use based on behavioral information obtained from questionnaire data obtained before the SIF's opening. Pearson's chi-square test was used to compare characteristics of IDUs who did and did not subsequently initiate SIF use. RESULTS: Overall, 400 active injection drug users returned for follow-up between December 1, 2003 and May 1, 2004, among whom 178 (45%) reported ever using the SIF. When we examined behavioral data collected before the SIF's opening, those who initiated SIF use were more likely to be aged <30 years (odds ratio [OR]=1.6, 95% confidence interval [CI]=1.0-2.7], p=0.04); public injection drug users (OR=2.6, 95% CI=1.7-3.9, p<0.001); homeless or residing in unstable housing (OR=1.7, 95% CI=1.2-2.7, p=0.008); daily heroin users (OR=2.1, 95% CI=1.3-3.2, p=0.001); daily cocaine users (OR=1.6, 95% CI=1.1-2.5, p=0.025); and those who had recently had a nonfatal overdose (OR=2.7, 95% CI=1.2-6.1, p=0.016). CONCLUSIONS: This study indicated that the SIF attracted IDUs who have been shown to be at elevated risk of blood-borne disease infection and overdose, and IDUs who were contributing to the public drug use problem and unsafe syringe disposal problems stemming from public injection drug use.

Adult↗
PubMed2005

Incarceration, addiction and harm reduction: inmates experience injecting drugs in prison.

Within Canadian prisons HIV/AIDS is becoming more common among inmates. While injection drug use in correctional facilities is documented to be a problem, qualitative research into the HIV risks faced by inmates is lacking. The goal of this research was to qualitatively examine HIV risk associated with injecting inside British Columbia prisons. A sample of 26 former male inmates who had recently used drugs within correctional facilities were recruited from a ongoing cohort study of injection drug users in Vancouver, Canada. Data for this study were collected through in-depth interviews conducted in 2001/2002. Analysis of these data involved identifying emergent themes and then exploring these central concepts in further interviews to confirm the accuracy of interpretation. The harms normally associated with drug addiction, and injection drug use are exacerbated in prison. Interpersonal relationships and the possession of exchangeable resources determine access to scarce syringes. The scarcity of syringes has resulted in patterns of sharing amongst large numbers of persons. Continual reuse of scarce syringes poses serious health hazards and bleach distribution is an inadequate solution. The findings of this study emphasize the need for effective harm reduction programs that provide an appropriate response to the problem of injection drug use among inmates.

Anecdotes as Topic↗
PubMed2005

Injection drug use, HIV/AIDS and incarceration: evidence from the Vancouver Injection Drug Users Study.

The reliance on law enforcement as the dominant drug policy approach has resulted in record incarceration rates in many countries. Human rights advocates and public health researchers have argued that the risks of HIV transmission resulting from injection drug use within Canadian prisons must be addressed. Despite a decade of advocacy and some progress made, this remains an urgent public health crisis. In light of these concerns, researchers working with the Vancouver Injection Drug Users Study (VIDUS) have undertaken a series of studies specific to injection drug use and HIV/AIDS in prisons. This article summarizes the body of evidence generated via VIDUS, discusses briefly the related human rights implications, and concludes with recommendations for action.

Antiretroviral Therapy, Highly Active↗
PubMed2004

Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users.

BACKGROUND: North America's first medically supervised safer injecting facility for illicit injection drug users was opened in Vancouver on Sept. 22, 2003. Although similar facilities exist in a number of European cities and in Sydney, Australia, no standardized evaluations of their impact have been presented in the scientific literature. METHODS: Using a standardized prospective data collection protocol, we measured injection-related public order problems during the 6 weeks before and the 12 weeks after the opening of the safer injecting facility in Vancouver. We measured changes in the number of drug users injecting in public, publicly discarded syringes and injection-related litter. We used Poisson log-linear regression models to evaluate changes in these public order indicators while considering potential confounding variables such as police presence and rainfall. RESULTS: In stratified linear regression models, the 12-week period after the facility's opening was independently associated with reductions in the number of drug users injecting in public (p < 0.001), publicly discarded syringes (p < 0.001) and injection-related litter (p < 0.001). The predicted mean daily number of drug users injecting in public was 4.3 (95% confidence interval [CI] 3.5-5.4) during the period before the facility's opening and 2.4 (95% CI 1.9-3.0) after the opening; the corresponding predicted mean daily numbers of publicly discarded syringes were 11.5 (95% CI 10.0-13.2) and 5.4 (95% CI 4.7-6.2). Externally compiled statistics from the city of Vancouver on the number of syringes discarded in outdoor safe disposal boxes were consistent with our findings. INTERPRETATION: The opening of the safer injecting facility was independently associated with improvements in several measures of public order, including reduced public injection drug use and public syringe disposal.

British Columbia↗
PubMed2004

Displacement of Canada's largest public illicit drug market in response to a police crackdown.

BACKGROUND: Law enforcement is often used in an effort to reduce the social, community and health-related harms of illicit drug use by injection drug users (IDUs). There are, however, few data on the benefits of such enforcement or on the potential harms. A large-scale police "crackdown" to control illicit drug use in Vancouver's Downtown Eastside provided us with an opportunity to evaluate the effect. METHODS: As part of our ongoing prospective cohort study of IDUs in Vancouver, we examined data collected from 244 IDUs in the 3 months before the police crackdown and from 142 IDUs in the 3 months after the start of the crackdown, on Apr. 7, 2003. All study subjects were active drug users. We also examined external data on needle exchanges and syringe disposal. RESULTS: The 2 groups of IDUs were statistically similar: they were mainly young (mean age 39 years) and male (63%), and they had injected illicit drugs for 13 years on average. Ethnic background and the proportion homeless were also similar. There were no statistically significant reported differences (all p > 0.1) in the street price of heroin, cocaine or "crack" in the 2 periods. In the 3-month periods before and after the crackdown, respectively, the rates of daily heroin injection were 27.9% and 26.8%, daily cocaine injection 28.7% and 27.5%, and daily crack use 59.4% and 60.6% (all p > 0.1). The proportions of study subjects receiving methadone treatment, 41.0% and 44.4% (p = 0.516), did not differ. However, the proportions reporting a change in where drugs were used, 22.5% and 33.8% (p < 0.05), and the proportions reporting a change in the neighbourhood of use because of police presence, 18.1% and 26.8% (p < 0.05), increased significantly. Needle-exchange data confirmed that the community levels of drug use were unchanged. Disposal statistics demonstrated that the monthly average number of used syringes found on the streets outside the traditional area of drug use increased from 784 in the 3 months before Apr. 1 to 1253 in the subsequent 3 months (p = 0.002) and the monthly average number of used syringes found in public boxes for the safe disposal of syringes decreased from 865 to 502 (p = 0.018). INTERPRETATION: The effort to control illicit drug use did not alter the price of drugs or the frequency of use, nor did it encourage enrollment in methadone treatment programs. Several measures indicated displacement of injection drug use from the area of the crackdown into adjacent areas of the city, which has implications for both recruitment of new initiates into injection drug use and HIV prevention efforts.

Adult↗
PubMed2003

The potential public health and community impacts of safer injecting facilities: evidence from a cohort of injection drug users.

BACKGROUND: Although medically supervised safer injecting facilities (SIFs) remain untested in North America, their implementation is currently being debated. Reluctance of health policy makers to initiate a pilot study of SIFs may in part be hindered by outstanding questions regarding the potential community and public health impact of the intervention. Specifically, it is presently unknown if those at greatest risk of overdose and HIV transmission or those responsible for community impact of injection drug use will be willing to attend. METHODS: The current study was conducted to evaluate the proportion of injection drug users (IDU) willing to attend medically supervised SIFs, if they were available, among participants enrolled in the Vancouver Injection Drug User Study (VIDUS). The authors also evaluated factors associated with willingness to use a SIF using univariate and logistic regression analyses. Participants who were followed from June 2001 to June 2002 were eligible for the present analyses. RESULTS: Overall, 587 active IDU responded to a questionnaire during the study period. Among respondents, 215 (36.6%) expressed willingness to attend a SIF. Variables that were independently associated with willingness to attend a SIF in multivariate analyses included having difficulty accessing sterile syringes (adjusted odds ratio [AOR] = 2.07), requiring help injecting (AOR = 1.52), frequently injecting heroin (AOR = 1.81), sex trade work (AOR = 2.02), and injecting in public spaces (AOR = 2.00). CONCLUSIONS: Several variables that have recently been associated with overdose, syringe sharing, HIV and HCV incidence, and community impact of illicit drug use in this setting were associated with willingness to attend medically supervised SIFs. Although the impact of SIFs in North America can only be quantified by scientific evaluation, these data indicate a high potential for immediate community and public health benefits if SIFs were presently available.

Adult↗
PubMedDate not supplied

Recent incarceration independently associated with syringe sharing by injection drug users.

OBJECTIVES: Few prospective studies are available on the relationship between incarceration and HIV risk among injection drug users (IDUs). The authors evaluated self-reported rates of syringe sharing and incarceration among a cohort of IDUs. METHODS: This study analyzed syringe lending by HIV-infected IDUs and syringe borrowing by HIV-negative IDUs among participants enrolled in the Vancouver Injection Drug Users Study (VIDUS). Since serial measures for each individual were available, variables potentially associated with each outcome (syringe lending and borrowing) were evaluated using generalized estimating equations for binary outcomes. RESULTS: The study sample consisted of 1,475 IDUs who were enrolled into the VIDUS cohort from May 1996 through May 2002. At baseline, 1,123 (76%) reported a history of incarceration since they first began injecting drugs. Of these individuals, 351 (31%) reported at baseline that they had injected drugs while incarcerated. Among 318 baseline HIV-infected IDUs, having been incarcerated in the six months prior to each interview remained independently associated with syringe lending during the same period (adjusted odds ratio [OR]=1.33; 95% confidence interval [CI] 1.06, 1.69; p=0.015). Similarly, among the 1,157 baseline HIV-negative IDUs, having been incarcerated in the six months prior to each interview remained independently associated with reporting syringe borrowing during the same period (adjusted OR=1.26; 95% CI 1.12, 1.44; p<0.001). CONCLUSIONS: Incarceration was independently associated with risky needle sharing for HIV-infected and HIV-negative IDUs. This evidence of HIV risk behavior should reinforce public health concerns about the high rates of incarceration among IDUs.

Adult↗
PubMedDate not supplied

Requiring help injecting as a risk factor for HIV infection in the Vancouver epidemic: implications for HIV prevention.

BACKGROUND: Requiring help injecting was recently associated with syringe sharing, and later HIV-1 and HCV seroconversion among injection drug users (IDU) in Vancouver. This risk factor remains poorly understood. The present study investigates this risk factor among Vancouver IDUs. METHODS: We evaluated factors associated with requiring help injecting among participants enrolled in the Vancouver Injection Drug User Study (VIDUS) using univariate and logistic regression analyses. VIDUS participants who were followed-up during the period December 2000 to December 2001 were eligible for the present analyses. We also evaluated self-reported reasons for requiring help injecting. RESULTS: Overall, 661 active injection drug users were interviewed during the study period. Among this population, 151 (22.8%) had required help injecting during the last six months, whereas 510 (77.2%) indicated that they had not. Variables that were independently associated with requiring help injecting included borrowing a used syringe (adjusted odds ratio [AOR] = 2.18), frequent cocaine injection (AOR = 1.57), and female gender (AOR = 2.29). Among males, the most common reasons for requiring help injecting were: having no viable veins (77.1%), and anxiousness or being drug sick (42.9%). Among females, the most common reasons reported were: having no viable veins (71.6%), jugular injection or 'jugging' (45.7%), and being anxious or drug sick (27.2%). Almost twice as many females (13.6% vs 7.1%) reported not knowing how to inject as their reason for requiring help injecting. CONCLUSION: Although current public health approaches, such as needle exchange, are unable to address the concerns associated with requiring help injecting, available evidence suggests that safer injecting facilities have the potential to substantially mitigate this risk behaviour.

British Columbia↗