Nurse-delivered injection education and subsequent injection drug use practices among street-involved youth

Background: Injection drug use is a risky activity associated with numerous negative health consequences. The delivery of injection education by nurses has been proposed as one approach to reduce injection-related harms. This study sought to assess coverage of nurse-delivered injection education and subsequent injection drug use behaviors among street-involved youth who use injection drugs.

Methods: Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use illicit drugs in Vancouver, Canada. Between September 2006 and June 2016, those who reported injection drug use were included in this study. Factors associated with having received nurse-delivered injection education at baseline were identified using logistic regression. A series of multivariable generalized estimating equations were then constructed to examine subsequent risk patterns among youth who had and had not received injection education at baseline.

Results: Of 559 youth who reported injection drug use, 167 (29.9%) indicated having received nurse-delivered injection education at baseline. Youth who received injection education were more likely to report living in the Downtown Eastside of Vancouver (Adjusted Odds Ratio [AOR]=2.16), binge drug use (AOR=1.71), and daily heroin use (AOR=1.68). In a series of multivariable GEE analyses, non-fatal overdose and HCV infection were positively associated with having received nurse-delivered injection education (p <0.05), while reporting injection related infections and requiring assistance to inject were not significantly associated with receiving injection education (p >0.05).

Conclusion: Study results indicate that nurse-delivered injection education appears to target high-risk participants. While, receiving injection education was not found to be significantly protective for subsequent high-risk practices, participants who received injection education were initially engaging in higher-risk substance use patterns. Although injection education may reduce engagement in high-risk practices, findings are consistent with existing research suggesting that providing information and education alone is unlikely to be sufficient to significantly reduce risky substance use practices.