Profile of Hepatitis C & Injection Drug Use in Canada

IDU in Canada

Information regarding rates and patterns of IDU is extremely difficult to obtain. As Millar (1998) explains, persons who inject drugs are often heavy, dependent users with a lifestyle that revolves around their drug use and marginalizes them from mainstream society. These are the visible, marginalized street population. There are also the hidden populations of injection drug users who may not fit the typical profile. Due to the illegal nature of the behaviour, as well as the negative societal view, it is difficult to obtain accurate information on the characteristics of people who inject drugs and injecting behaviors. Much of the available information is based on best estimates, obtained from relatively accessible treatment populations such as clients in needle exchange programs, methadone maintenance or other addictions treatment programs.

This section examines the extent of IDU in Canada, characteristics of those who inject drugs and a discussion of high-risk groups. Much of the information contained in this section is from the Health Canada report "A Socio-Demographic Profile of Drug Users in Canada" (Single, 2000).

Prevalence of IDU

The extent of IDU in Canada is not known, but it is estimated that there are between 75,000 and 125,000 people who inject drugs in Canada (Single, 2000), approximately one-third of whom are women. Most reside in Toronto, Vancouver and Montreal. It is estimated that 30,000 people who inject drugs reside in Toronto (Remis et al., 1997), and 15,000 in Vancouver (Millar, 1998). In Montreal, the number of people who inject cocaine is estimated between 6,000 and 25,000 and for heroin between 5,000 and 15,000 (Roy and Cloutier, 1994). Although there are no estimates for Quebec City or Ottawa, it is believed that a significant amount of IDU occurs in these cities as well. In addition, 29.4% of young steroid users, or approximately 25,000 Canadians, report injection use (CCDFS, 1993).

Types of Drugs

The most commonly injected drugs are cocaine and heroin. This is a cause for concern in itself, as cocaine use involves particular risk. Persons who inject cocaine inject as often as twenty times a day, increasing the problems associated with obtaining clean needles and sharing contaminated needles (McAmmond and Associates, 1997). Information obtained through detailed interviews with 610 individuals who inject drugs in Winnipeg, Manitoba (Elliot and Blanchard, 1998) found cocaine to be the predominant drug injected, and was associated with binge use and frequent injection. Talwin, Ritalin, amphetamines and steroids have also been used intravenously in some areas of Canada at various times (Single, 2000).

Needle-Sharing

The proportion of people who report sharing needles varies considerably, but is exceedingly high in many communities: 76% in Montreal (Bruneau et al., 1997), 69% in Vancouver (Strathdee et al., 1997), 64% in a semi-rural Nova Scotia community (Stratton et al., 1997), 54% in Quebec City (Belanger et al., 1996) and Calgary (Elnitsky and Abernathy, 1993), 46% in Toronto (Myers et al., 1995) and 37% in Hamilton-Wentworth (Devillaer and Smye, 1994).

Strathdee and colleagues (1997) conducted a study with 281 people involved in IDU from Vancouver, British Columbia that examined the social determinants predictive of needle-sharing behaviour. Factors that were independently associated with needle-sharing included injecting four or more times/day, polydrug use, and a history of sexual abuse. With regard to sexual abuse, the authors hypothesized that a history of sexual abuse may be related to low self-esteem and depression, which in turn could make individuals less concerned about safe needle practices. Access or barriers to clean needle use was not associated with needle-sharing.

Belanger et al. (1996) examined the indicators of risk that discriminate those sub-groups that are at high risk of sharing needles and other drug paraphernalia. The sample included clients participating in the needle exchange program in Quebec City. More than half of the participants (54.1%) reported having shared at least one used needle during the six months before the interview. Factors related to needle-sharing included multi-drug use, frequenting a shooting gallery, and injecting in the presence of people not well known. Females and young people (under the age of 20 years) were more inclined than males and older clients, respectively, to adopt unsafe injecting practices. A discussion of potential reasons that place women and youth at greater risk of unsafe practices is provided in the section "HCV and At-Risk Populations."

Demographic Characteristics

In an attempt to delineate the characteristics associated with IDU in Canada, Single (2000) synthesized information from some 20 different Canadian studies. A description of these studies is contained in Table 1 (see Appendix). It is important to note that the information in this section is based on the characteristics of clients in needle exchange programs and/or treatment programs and as such, may not reflect the overall population of people who inject drugs in Canada.

The ratio of male to female injection drug use in these studies vary from 1.6:1 (SADAC, 1993) to 6.1:1, reflecting differences in outreach and client requirements (Millson et al., 1995). The overall average is 3 to 1, indicating that approximately one fourth of those who inject drugs are women. While there is a great variation in age, the mean age of those involved in injection drug use is the early 30s for men and the late 20s for women. The reasons for these gender differences are not clear. However, research with young users of injection drugs suggests that females are initiating injection drug use at an earlier age than males. This research will be discussed further in the section "HCV and At-Risk Populations."

The average age of IDU in these studies ranged from 28 to 35, but substantial numbers are under the age of 20 years. For instance, more than one in five individuals who injected drugs in a recent study conducted in Quebec City were teenagers (Belanger et al., 1996). Although it is difficult to recognize a trend with only sixteen studies, there are indications that the average age of participants in needle exchange programs has increased somewhat over the past few years. The (unweighted) mean age of the five most recent studies is 32 years of age, which is higher than reported for any of the prior studies.

Only five of the 20 studies reported marital status. While the proportion that is single ranges widely from 38% (Millson et al., 1990) to 76% (Hewitt and Vinge, 1991), the majority of study participants from the five studies were single.

Compared to clients who do not inject drugs, those who inject drugs have lower educational attainment. Although there is a wide range, the majority of IDU occurs among high school dropouts. Rates of incomplete high school in various locations are as follows: 81% in Vancouver (Strathdee et al., 1997), 63% in a semi-rural community in Nova Scotia (Stratton et al., 1997), 61% in Quebec City (Poulin et al., 1995), 57% in Calgary (Elnitsky and Abernathy, 1993), 52% in Edmonton (Wolfe and Sykes, 1992). Toronto observed higher rates of completed high school, with 37% having less than a high school education (Millson et al., 1990).

Most people involved in IDU are unemployed. Rates of unemployment range from 43% in Cape Breton (Poulin et al., 1992) to 88% in Montreal (Bruneau, 1994), 87% in Edmonton (Wolfe and Sykes, 1992) and 77% in Toronto (Millson et al., 1995). In Vancouver, 88% of participants were on social assistance (Archibald et al., 1996). As such, it is not surprising that IDU is generally associated with low incomes. Although few studies report income, it is noteworthy that 40% of individuals involved with IDU in Montreal earn less than $10,000 per year and 71% earn less than $25,000 (Brunea et al., 1997).

Back