High rates of injection drug use in urban Aboriginal youth signal need for prevention programs

Aboriginal leadership is alarmed at the levels of substance abuse in their young people, especially injection drug use, which is associated with HIV and hepatitis C virus infections. Injection drug use accounts for 70%-80% of all hepatitis C virus and almost 60% of HIV infections in Aboriginal youth under age 24 in Canada. The history of colonization, including the effect of residential schooling on several generations and the child welfare system, has had significant negative effects on Aboriginal communities. Many children and youth have experienced physical, sexual and emotional abuses as well as exposure to familial violence and drug dependence.

The Cedar Project is a prospective study of 605 Aboriginal youth in Vancouver and Prince George, British Columbia, conducted from 2003 to 2007 that sought to understand use of illicit drugs, particularly relating to infection with HIV. Participants were between the ages of 14 and 30 years and had smoked or injected illicit drugs, other than marijuana, in the month before enrolment. The median age was 23, and 292 (48.3%) were women.

At the start of the study, 335 (55.4%) of participants reported a history of injection drug use. Injection drug users were more likely to be women, to be older, to identify as gay, lesbian, bisexual or two-spirited, to have experienced sexual abuse, to have a parent who attended a residential school and to have other risk factors. In participants who had no history of injection drug use and who attended at least one follow-up visit (197 out of 270), 39 people (18 men, 21 women) began to inject drugs.

Young Aboriginal women were twice as likely to inject drugs as men.

"In our study population, about 11 participants per 100 person-years will transition to injection drug use -- a rate that is almost twice as high as that found in the only other available longitudinal study done in Canada investigating transition to injection drug use among young people (6.8 per 100 person-years in Montréal, Quebec)," states Dr. Patricia Spittal, School of Population and Public Health, University of British Columbia, with coauthors. "Transition to injection drug use at a young age not only increases the risk of contracting an infectious disease, it also further entrenches the young person in an increasingly dangerous street life that often involves sex work, violence, predation and life-long addiction."

The study was conducted by researchers from the School of Population and Public Health, University of British Columbia; Simon Fraser University; the Centre for Health Evaluation and Outcome Sciences at Providence Health Care; the Wuikinuxv Nation, Port Hardy, BC; and the Splats'in/Secwepemc Nation, Enderby, BC.

"This study documents an unacceptable number of young, at-risk Aboriginal people transitioning to injection drug use every year; however, there are no prevention programs tailored specifically to this population," states Chief Wayne Christian and coauthors. "Support for community-based programs that address the potential for drug dependence within the context of sexual trauma should be prioritized to respond to the dual epidemics of injection drug use and blood-borne infection among Aboriginal people," they conclude.