Investigating a bidirectional relationship between overdose and provision of injection initiation assistance among persons who inject drugs in Vancouver, Canada and Tijuana, Mexico.
Investigating a bidirectional relationship between overdose and provision of injection initiation assistance among persons who inject drugs in Vancouver, Canada and Tijuana, Mexico.
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DOI：
10.1016/j.drugpo.2021.103398
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Werb D
中科院分区：
文献类型：
--
作者：
Bowles JM;Jain S;Sun X;Strathdee SA;DeBeck K;Milloy MJ;Bouck Z;Werb D
注射毒品的使用往往是在了解注射知识的同伴的帮助下开始的。在注射开始事件中帮助同伴的人经常注射，这增加了过量的风险。因此，药物过量和注射开始事件可能相关。为了探索潜在的关系，我们评估了在两个北美城市--加拿大温哥华和墨西哥蒂华纳--的注射毒品者中经历非致命性过量和协助他人开始注射毒品使用之间的时间关联。从2014年到2018年，这项回顾性队列研究包括来自温哥华（n = 1332）和天津（n = 666）的注射毒品的人，他们完成了基线和6个月的随访。在每个研究中心内，我们使用两个单独的多变量逻辑回归模型评估了双向时间关联：对于模型1，最近提供的注射启动辅助（6个月）是结局，最近用药过量（基线）是暴露;而模型2，最近用药过量（6个月）是结局，最近提供的注射启动辅助（基线）是暴露。两种模型均针对潜在混杂因素进行了调整。在基线时报告用药过量的温哥华参与者在随访时报告注射开始援助的可能性高出163%（调整后的比值比[aOR] 2.63; 95%置信区间[CI] 1.41 - 4.90）;而基线时报告注射开始辅助的参与者在随访时报告非致死性药物过量的比值高89%（aOR 1.89; 95% CI 1.00 - 3.57）。我们基于蒂华纳的结果没有得出任何关联。温哥华的研究结果表明，注射启动辅助和过量是一种双向相关的现象。目前的调查结果强调，需要采取干预措施，确保提供注射开始援助的人得到过量预防支持，无论是为他们自己还是为他们帮助开始注射吸毒的人。虽然我们在蒂华纳的研究结果并没有表明存在双向关系，但仍应采取预防措施。
Injection drug use is often initiated by assistance from an injection-knowledgeable peer. Persons who assist peers in injection initiation events often inject frequently, which heightens overdose risk. As such, overdose and injection initiation events may be correlated. To explore a potential relationship, we assessed temporal associations between experiencing a non-fatal overdose and assisting others in initiating injection drug use among persons who inject drugs in two North American cities – Vancouver, Canada and Tijuana, Mexico. From 2014–2018, this retrospective cohort study included people who inject drugs from Vancouver (n=1332) and Tijuana (n=666) who completed a baseline and six-month follow-up interview. Within each site, we assessed bidirectional temporal associations using two separate multivariable logistic regression models: for model 1, recent provision of injection initiation assistance (at six months) was the outcome and recent overdose (at baseline) was the exposure; whereas; model 2, recent overdose (at six months) was the outcome and recent provision of injection initiation assistance (at baseline) was the exposure. Both models adjusted for potential confounders. Vancouver-based participants reporting overdose at baseline had 163% greater odds of reporting injection initiation assistance at followup (adjusted Odds Ratio [aOR] 2.63; 95% Confidence Interval [CI] 1.41–4.90); while participants reporting injection initiation assistance at baseline had 89% greater odds of reporting a non-fatal overdose at followup (aOR 1.89; 95% CI 1.00–3.57). Our Tijuana-based results did not conclude any associations. Findings in Vancouver suggest that injection initiation assistance and overdose are a bidirectionally-associated phenomena. The present findings highlight the need for interventions that ensure that persons who provide injection initiation assistance are given overdose prevention support, both for themselves and for those they assist to initiate injection drug use. While our Tijuana-based results did not suggest a bidirectional relationship, preventative approaches should nonetheless be undertaken.
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