title: Injection drug use cessation and use of North America's first medically supervised safer injecting facility.
abstract: BACKGROUND
  Vancouver, Canada has a pilot supervised injecting facility (SIF), where individuals can inject pre-obtained drugs under the supervision of medical staff. There has been concern that the program may facilitate ongoing drug use and delay entry into addiction treatment.
  
  
  METHODS
  We used Cox regression to examine factors associated with the time to the cessation of injecting, for a minimum of 6 months, among a random sample of individuals recruited from within the Vancouver SIF. In further analyses, we evaluated the time to enrollment in addiction treatment.
  
  
  RESULTS
  Between December 2003 and June 2006, 1090 participants were recruited. In Cox regression, factors independently associated with drug use cessation included use of methadone maintenance therapy (Adjusted Hazard Ratio [AHR] = 1.57 [95% Confidence Interval [CI]: 1.02-2.40]) and other addiction treatment (AHR = 1.85 [95% CI: 1.06-3.24]). In subsequent analyses, factors independently associated with the initiation of addiction treatment included: regular SIF use at baseline (AHR = 1.33 [95% CI: 1.04-1.72]); having contact with the addiction counselor within the SIF (AHR = 1.54 [95% CI: 1.13-2.08]); and Aboriginal ancestry (AHR = 0.66 [95% CI: 0.47-0.92]).
  
  
  CONCLUSIONS
  While the role of addiction treatment in promoting injection cessation has been well described, these data indicate a potential role of SIF in promoting increased uptake of addiction treatment and subsequent injection cessation. The finding that Aboriginal persons were less likely to enroll in addiction treatment is consistent with prior reports and demonstrates the need for novel and culturally appropriate drug treatment approaches for this population.
authors.affiliation: BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada.
authors.forename: Kora
authors.initials: K
authors.lastname: DeBeck
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Lorna
authors.initials: L
authors.lastname: Bird
authors.forename: Ruth
authors.initials: R
authors.lastname: Zhang
authors.forename: David
authors.initials: D
authors.lastname: Marsh
authors.forename: Mark
authors.initials: M
authors.lastname: Tyndall
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000328:Adult; D002170:Canada; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology; D016320:Substance Abuse Treatment Centers / Q000379:methods*; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000534:rehabilitation*; D013997:Time Factors
references.citation: N Engl J Med. 2006 Jun 8;354(23):2512-4
references.pmid: 16760459
references.citation: Drug Alcohol Depend. 2006 Jun 28;83(2):147-56
references.pmid: 16364568
references.citation: Subst Use Misuse. 2005;40(8):1153-67
references.pmid: 16040375
references.citation: Lancet. 2005 Jul 23-29;366(9482):316-8
references.pmid: 16039335
references.citation: CMAJ. 2006 Oct 10;175(8):859
references.pmid: 17030931
references.citation: Am J Epidemiol. 1997 Apr 15;145(8):730-7
references.pmid: 9125999
references.citation: Am J Public Health. 2001 Jul;91(7):1060-8
references.pmid: 11441732
references.citation: Int J Drug Policy. 2008 Jun;19(3):220-5
references.pmid: 18551754
references.citation: CMAJ. 2004 Sep 28;171(7):731-4
references.pmid: 15451834
references.citation: Addiction. 2007 Jun;102(6):916-9
references.pmid: 17523986
references.citation: Soc Sci Med. 1994 Jan;38(1):67-78
references.pmid: 8146717
references.citation: Harm Reduct J. 2004 Nov 09;1(1):9
references.pmid: 15535885
references.citation: Am J Prev Med. 2005 Aug;29(2):126-30
references.pmid: 16005809
references.citation: CMAJ. 2007 Jul 3;177(1):37-40
references.pmid: 17606937
references.citation: Lancet Infect Dis. 2004 May;4(5):301-6
references.pmid: 15120347
references.citation: BMJ. 2000 Mar 11;320(7236):667
references.pmid: 10710565
references.citation: Drug Alcohol Depend. 2009 May 1;101(3):152-7
references.pmid: 19181458
references.citation: BMJ. 2004 Jan 10;328(7431):100-2
references.pmid: 14715606
references.citation: J Psychoactive Drugs. 1992 Jan-Mar;24(1):41-7
references.pmid: 1619521
references.citation: Drug Alcohol Rev. 2008 Nov;27(6):602-12
references.pmid: 19378444
references.citation: Drug Alcohol Rev. 2003 Jun;22(2):227-33
references.pmid: 12850909
references.citation: Drug Alcohol Depend. 2006 Jul 27;83(3):193-8
references.pmid: 16356659
references.citation: Am J Epidemiol. 1997 Dec 15;146(12):1003-6; discussion 1007-10
references.pmid: 9420523
references.citation: Am J Epidemiol. 2003 Oct 1;158(7):695-704
references.pmid: 14507606
references.citation: Addiction. 2009 Jan;104(1):69-76
references.pmid: 19133890
references.citation: CMAJ. 2003 Nov 11;169(10):1063
references.pmid: 14609983