title: Inability to access addiction treatment predicts injection initiation among street-involved youth in a Canadian setting.
abstract: BACKGROUND
  Preventing injection drug use among vulnerable youth is critical for reducing serious drug-related harms. Addiction treatment is one evidence-based intervention to decrease problematic substance use; however, youth frequently report being unable to access treatment services and the impact of this on drug use trajectories remains largely unexplored. This study examines the relationship between being unable to access addiction treatment and injection initiation among street-involved youth.
  
  
  METHODS
  Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth aged 14-26 who use illicit drugs, from September 2005 to May 2014. An extended Cox model with time-dependent variables was used to identify factors independently associated with injection initiation.
  
  
  RESULTS
  Among 462 participants who were injection naïve at baseline, 97 (21 %) initiated injection drug use over study follow-up and 129 (28 %) reported trying but being unable to access addiction treatment in the previous 6 months at some point during the study period. The most frequently reported reason for being unable to access treatment was being put on a wait list. In a multivariable Cox regression analysis, being unable to access addiction treatment remained independently associated with a more rapid rate of injection initiation (Adjusted Hazard Ratio =2.02; 95 % Confidence Interval: 1.12-3.62), after adjusting for potential confounders.
  
  
  CONCLUSIONS
  Inability to access addiction treatment was common among our sample and associated with injection initiation. Findings highlight the need for easily accessible, evidence-based addiction treatment for high-risk youth as a means to prevent injection initiation and subsequent serious drug-related harms.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada. urhi-kd@cfenet.ubc.ca.|School of Public Policy, Simon Fraser University, Vancouver, Canada. urhi-kd@cfenet.ubc.ca.
authors.forename: Kora
authors.initials: K
authors.lastname: DeBeck
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada. uhri-tk@cfenet.ubc.ca.|Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada. uhri-tk@cfenet.ubc.ca.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada. seonaidn@gmail.com.|Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada. seonaidn@gmail.com.
authors.forename: Seonaid
authors.initials: S
authors.lastname: Nolan
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada. hdong@cfenet.ubc.ca.
authors.forename: Huiru
authors.initials: H
authors.lastname: Dong
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada. jmontaner@cfenet.ubc.ca.|Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada. jmontaner@cfenet.ubc.ca.
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada. uhri-ew@cfenet.ubc.ca.|Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada. uhri-ew@cfenet.ubc.ca.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D016739:Behavior, Addictive / Q000453:epidemiology* / Q000628:therapy*; D002170:Canada / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D018453:Homeless Youth / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000628:therapy*; D055815:Young Adult