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The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street-drug users

Authors

  • Julie Bruneau,

    Corresponding author
    1. Research Center, Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
    2. Department of Family Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
      Julie Bruneau, Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Pavillon Edouard Asselin, 264 René-Lévesque est, Montréal, Canada QC H2X 1P1. E-mail: julie.bruneau@umontreal.ca
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  • Élise Roy,

    1. Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
    2. Montreal Public Health Department, Agence de la santé et des services sociaux de Montréal, Montréal, Québec, Canada
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  • Nelson Arruda,

    1. Independent Investigator and Consultant, Montréal, Québec, Canada
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  • Geng Zang,

    1. Research Center, Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
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  • Didier Jutras-Aswad

    1. Research Center, Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
    2. Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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Julie Bruneau, Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Pavillon Edouard Asselin, 264 René-Lévesque est, Montréal, Canada QC H2X 1P1. E-mail: julie.bruneau@umontreal.ca

ABSTRACT

Aims  To examine trends in prescription opioid (PO) injection and to assess its association with hepatitis C virus (HCV) seroconversion among injection drug users (IDUs).

Design  Prospective cohort study.

Setting  Montreal, Canada.

Participants  HCV-negative IDUs at baseline, reporting injection in the past month.

Measurements  Semi-annual visits included HCV antibody testing and an interview-administered questionnaire assessing risk behaviours. HCV incidence rate was calculated using the person–time method. Time-updated Cox regression models were conducted to examine predictors of HCV incidence.

Findings  The proportion of IDUs reporting PO injection increased from 21% to 75% between 2004 and 2009 (P < 0.001). Of the 246 participants (81.6% male; mean age 34.5 years; mean follow-up time 23 months), 83 seroconverted to HCV [incidence rate: 17.9 per 100 person-years; 95% confidence interval (CI) 14.3, 22.1]. Compared to non-PO injectors, PO injectors were more likely to become infected [adjusted hazard ratio (AHR): 1.87; 95%CI:1.16, 3.03]. An effect modification was also found: PO injectors who did not inject heroin were more likely to become infected (AHR: 2.88; 95%CI: 1.52, 5.45) whereas no association was found for participants using both drugs (AHR: 1.19; 95% CI: 0.61, 2.30). Other independent predictors of HCV incidence were: cocaine injection, recent incarceration and >30 injections per month.

Conclusions  Prescription opioid injectors who do not inject heroin are at greater risk for HCV seroconversion than are those injecting both heroin and prescription opioids. Important differences in age, behaviour and social context suggest a need for targeted outreach strategies to this population.

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