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Injection Drug Use

7.1 Use

General Population

Youth and Young Adults

  • Less than 0.5% of Ontario high school students (grades 9-12) reported IDU in the past year (2015), a decrease from 1.4% in 2011, according to the OSDUHS (n=10,426).3

Special Populations

Indigenous Populations

  • 20.4% of IDUs self-identified as Aboriginal (17% First Nations; 2.8% Metis) among an Ontario sub-sample of (n=775) IDUs from the national I-Track survey (2005-08).18

Racialized Populations

  • A small minority (5.9%) of IDUs identified as an ethnicity other than North American, Aboriginal or European among an Ontario sub-sample of (n=775) IDUs from the national I-Track survey (2005-08).18

Homeless and Street-Involved Populations

  • One quarter (23%) of Toronto-based homeless adults reported injecting drugs (past-year) based on a random sample (n=368; 2006-07).11
  • One third (35%) of a sample of Toronto's homeless youth reported previously injecting drugs, 33% did so in the past 6 months, 39% did so daily. Of those who had injected, 23% injected heroin, 19% oxycodone and 19% cocaine, based on a convenience sample of (n=100) homeless youth (aged 16-24) who use substances surveyed in Toronto (Drugs, Homelessness and Health survey, 2008-09).14
  • 30.4% of Thunder Bay street-involved/at-risk youth (age ≤24) reported previously injecting drugs in a (2004) convenience sample of (n=313) youth who use or were at risk of using drugs.96

Correctional Populations

Pregnant and Parenting Women

  • There are no publicly-available provincial data on women's IDU during pregnancy.

Opioid Users

  • Past-month IDU decreased from 64.8% to 37.5% between 2002 (n=141) and 2005 (n=124) among a sub-sample of regular opioid-using IDUs (aged 18+) in Toronto, based on the pan-Canadian OPICAN study.41,68,98

Injection Drug Users

  • More than three quarters (78.0%) of a sample of IDUs in Ontario sites reported injecting at least once a week (past 6 months); 38.9% injected daily. The greatest proportion of IDUs (69.0%) reported injecting cocaine (past 6 months), followed by OxyContin (55.6%). Cocaine was injected most often (28.0% of the time), followed by non-prescribed morphine (20.5% of the time) (2007; Ontario Harm Reduction Distribution Program Evaluation).17
  • Cocaine was the most commonly injected drug in Ontario, with more than three quarters (77.0%) reporting injecting cocaine (past 6 months) among an Ontario sub-sample of (n=775) IDUs from the national I-Track survey (2005-08). In addition, 60.3% reported injecting non-prescribed morphine, 49.5% hydromorphone and 43.7% oxycodone; 73.0% reported injecting at their own apartment/house and 63.9% reported injecting alone, while 28.6% injected daily (past-month).18
  • Toronto illicit opioid users had the lowest rate (57.0%) of (past 30 day) injection compared to those in Edmonton, Montreal, Quebec City, and Vancouver, which all had injection rates over 80%, based on the 2002 pan-Canadian OPICAN study (n=677).99
  • The average frequency of PO injection was 4-5 times/day among a convenience sample of (n=25) illicit PO users (aged 18+) in Toronto in 2007. Half (50%) reported a history of injecting fentanyl (past 3 months); OxyContin was reported as the most common and readily available PO on the streets.100,101

Recreational Drug Users

7.2 Risks and Harms

Needle Sharing

  • The rate of shared needle use (past 6 month) decreased from 19.0% (2006) to 15.9% (2007) among a sample of (n=1,642) IDUs in Ontario sites. However, the rate of IDUs who lent or sold used needles remained stable (from 13.5% to 13.2%) (Ontario Harm Reduction Distribution Program Evaluation).17 
  • One in five (19.0%) IDUs in Ontario sites reported using a shared needle/syringe (past 6 months; 2005-08). A minority (16.7%) who injected with used equipment did so usually or always; the majority (65.8%) borrowed their needle from a regular sex partner. One quarter (23.1%) reported that a needle/syringe they had used was used by others among an Ontario sub-sample of (n=775) IDUs from the national I-Track survey.18
  • One third (33.3%) of a sub-sample of (n=39) Toronto-based opioid-using IDUs (aged 18+) reported sharing injection equipment in the past month (2005); this rate was an increase from 27.8% in 2002 (n=79), based on Toronto-specific data from the convenience-sampled, pan-Canadian OPICAN study.41,68
  • Over one in five (21%) of a sub-sample of (n=33) homeless youth (aged 16-24) in Toronto who reported IDU injected with a shared needle/syringe; 36% used other shared injection equipment (Drugs, Homelessness and Health survey, 2008-09).14

Injection Initiation

  • 27.4% of a sample of (n=98) Toronto-based current IDUs reported giving anyone their first injection. Odds of initiating non-IDUs increased with length of IDU history, being unemployed and having ever spoken positively about injecting to a non-injector, based on a 2011 respondent-driven sample (age 16+).102
  • An average of 2 people/year were initiated into IDU by IDUs who had previously injected someone else, based on qualitative interviews with a sample of (n=20) Toronto-based current IDUs (2009).103

Morbidity and Mortality

Human Immunodeficiency Virus

  • 7.1% of new Human Immunodeficiency Virus (HIV) diagnoses in Ontario were among IDUs in 2012. This was a decrease from 16.4% in 1996 when monitoring of HIV by the Ontario HIV Epidemiologic Monitoring Unit began.104
  • 4.1% of IDUs at Ontario harm reduction sites who underwent testing for HIV tested positive. The majority (86.4%) had previously been tested for HIV and 59.3% of those who had been tested had done so less than a year ago (2007;  Ontario Harm Reduction Distribution Program Evaluation).17
  • 4.9% tested positive for HIV among a sub-sample of (n=775) IDUs from Ontario sites in the national I-Track survey (2005-08). Most (92.3%) had been previously tested for HIV, among whom the majority (67.8%) had been tested in the past year. 82.1% of those who reported receiving a positive HIV test were in care for their HIV, with 61.1% currently taking prescribed drugs for HIV.18
  • In 2002, 14.8% of a sub-sample of (n=141) Toronto-based opioid users (aged 18+) were HIV+, based on Toronto-specific data from the convenience-sampled, pan-Canadian OPICAN study.68
  • While 2.4%  of all new HIV diagnoses in Ontario (n=1,358) between 2009 and 2011 were among Aboriginals, 32.3% of those diagnoses were attributed to IDU, which was the highest rate of IDU-attributed cases among any group, based on all new HIV diagnoses in Ontario 2009-11.105

Hepatitis C Virus

  • IDU was a main risk factor for an estimated 53.7% of all Hepatitis C Virus (HCV) infected persons in Ontario in 2007, with 48.5% of past IDUs and 58.0% of current IDUs estimated to be HCV+. IDUs were the vast majority (96.0%) of people in Ontario who were diagnosed to be co-infected with HCV and HIV (Ontario HIV Epidemiologic Monitoring Unit).106
  • Almost half (47.3%) of a sub-sample of (n=1,346) Ontario-based IDUs tested reported a positive HCV result from their most recent HCV test. The majority (84.4%) reported previously being tested for HCV; of those tested, 56.8% had done so within the last year (2007; Ontario Harm Reduction Distribution Program Evaluation).17
  • Most (61.3%) IDUs among a sub-sample in four Ontario sites who had been tested had a HCV+ test result, among an Ontario sub-sample of (n=775) IDUs from the national I-Track survey (2005-08). Almost half (49.5%) of those HCV+ were in care for their HCV, with 9.8% currently taking prescribed drugs.18
  • Half (49.2%) of a sub-sample of (n=120) Toronto-based opioid users were HCV+ in 2002, based on Toronto-specific data from convenience sample of illicit opioid users (aged 18+) in the pan-Canadian OPICAN study.107
  • 6.0% of a sample of (n=100) homeless youth in Toronto who reported drug use had previously been diagnosed with or treated for HCV (Drugs, Homelessness and Health survey, 2008-09).14

7.3 Interventions

Needle Exchange Programs

  • As of 2016, Ontario had 36 Public Health Units and approximately 180 satellite sites which offered NEPs.108 The Ontario Harm Reduction Distribution Program distributed 2,560,000 cookers to NEPs across Ontario in 2012 and 412,000 in 2007, representing a fivefold increase.108 In 2012, the Ontario Harm Reduction Distribution Program also ordered 19,109,750 filters, 1,038,000 units of ascorbic acid, and 4,838,100 sterile water ampoules for Ontario-based NEPs.109
  • The vast majority (93.0%) of a sample of Ontario-based IDUs reported previously using their local NEP and 35.0% reported using it at least once/week in the past 6 months (2007). 69.0% of those who collected injection drug supplies during their visit did so for both themselves and others while 13.2% reported lending/selling/giving their used needle to someone else (past 6 months; 2007; Ontario Harm Reduction Distribution Program Evaluation).17
  • Almost all (90.0%) of a sub-sample of (n=775) IDUs (age 15+) in Ontario sites reported previously using an NEP; 58.0% reported usually returning used needles/syringes to an NEP (2005-08 I-Track).18
  • In 2002, nearly half (46.8%) of a sub-sample of (n=141) Toronto-based opioid users reported using an NEP in the past 6 months according to Toronto-specific data from the convenience-sampled, pan-Canadian OPICAN study.68
  • A quarter (25%) of Toronto-based homeless adults said they could not access clean needles or SCUKs when they needed them in the past year; 59% said that they would use an NEP to help them reduce, control, or make their drug use safer if it were free and easily accessible (n=368, 2006-07).11
  • About half (46%) of a sub-sample of (n=33) Toronto-based homeless youth who injected drugs in past month reported that the most frequent source of their needles was from an on-site NEP, but 21% reported never using an NEP (Drugs, Homelessness and Health survey, 2008-09).14

Safer Injection Facilities

  • Ontario does not have any safer injection facilities (SIFs) as of 2016. The only such facilities in North America are located in Vancouver, British Columbia. Toronto city council has approved 3 SIFs for the city but still requires federal approval.110 Ottawa's Board of Health supports SIFs in Ottawa but approval is still needed from other stakeholders.111 Hamilton, London and Thunder Bay are currently conducting research to assess the feasibility of SIFs in their cities.112,113
  • More than half (56%) of the Ontario public strongly agreed that SIFs should be implemented to reduce neighborhood problems in 2009, which was an increase from 31% in 2003; 48% thought that SIFs should be implemented to increase contact of people who use drugs with health and social workers, 48% thought that the SIFs should be implemented to reduce overdose deaths or infectious disease among people who use drugs and 31% thought they should be implemented to encourage safer drug injection, according to surveys representative of Ontario adults (aged 18+) in 2003 (n=1,229) and 2009 (n=1,035).114 In 2009, public support for supervised smoking facilities was lower than for supervised injecting facilities (20% vs. 28%).115
  • Three in four (75%) people who inject and smoke drugs in Toronto (n=361) and Ottawa (n=215) reported they would use an SIF, according to an I-Track sub-sample (2006).116
  • Over three quarters (75.2%) of a sample of (n=270) Ottawa-based drug users (aged 16+) were willing to use an SIF and 50.7% reported they would use one daily if it opened right away, based on the 2013 Participatory Research in Ottawa: Understanding Drugs (PROUD) prospective cohort study.117

Treatment

  • A lifetime history of intravenous drug use was reported by 16.5% (17,554 admissions) of people admitted to publicly-funded substance abuse treatment in Ontario in 2012-13, with 10.0% reporting doing so in the past year. Males accounted for the majority (64.8%) of the 12,020 Ontario-based episodes related to treatment for IDU in 2012-13, based on information from DATIS compiled in the National Treatment Indicators Report.72,118,119