Prevalence of injection drug use among male offenders

Injection drug use (IDU) contributes to the transmission of blood-borne diseases and other health concerns, such as soft-tissue infections (e.g. abscesses) and/or scarring of peripheral veins. Among federal offenders ever tested for HIV or HCV infection, 4.6% self-reported being HIV positive and 31% HCV positive (Zakaria et al., 2010). In comparison, the prevalence of HIV and HCV infection in the Canadian adult population is 0.3% and 0.8%, respectively (UNAIDS, 2006; Zou et al., 2001).

Using data provided by 13,161 offenders who completed the Computerized Assessment of Substance Abuse (CASA)^{Footnote 1} between 2002 and 2009, we examined lifetime IDU. This review describes substance use patterns and health behaviours of IDU offenders and examines IDU within two mutually exclusive time periods for certain indicators:

1. past IDU - IDU which did not include the twelve months prior to arrest for current offence(s),
2. and recent IDU – IDU which included the twelve months prior to arrest for current offence(s).

What we found: IDU prevalence among offenders

Lifetime IDU was reported by 21% (n=2,793) of offenders in the sample. Within this group 51% indicated recent IDU. The overall prevalence of IDU varied across regions, from a high of 32% in the Pacific Region to a low of 16% in the Quebec Region^{Footnote 2}. Offenders incarcerated in the Pacific Region reported the highest prevalence of past and recent IDU (14% and 18%, respectively)^{Footnote 3}.

On average, offenders who reported a history of IDU first experimented with drugs at age 15 and reported weekly drug use at 18. Among offenders who reported recent IDU, regardless of method of use, opioids (44%) were used most frequently,^{Footnote 4} followed by cocaine (22%), crack cocaine (20%), and cannabinoids (9%). In comparison to these results, offenders indicating past IDU reported using the following drugs most frequently: cannabinoids (33%), crack cocaine (30%), cocaine (14%), and opioids (13%)^{Footnote 5}. Almost all offenders (94%) who had a recent IDU history were assessed with a ‘moderate’ to ‘severe’ drug dependency problem on the Drug Abuse Screening Test (DAST, Skinner, 1982), while only 57% of offenders reporting past IDU were assessed with a ‘moderate’ to ‘severe’ drug dependency (see Figure 1).

Among offenders indicating lifetime IDU, almost half (43%) acknowledged sharing needles while 55% indicated sharing injection equipment such as cookers, water, filters, and/or cotton swabs. About a quarter (24%) of the offenders indicated that they had practiced “front-loading” (a method that uses one syringe to mix drugs that are then transferred to multiple syringes for injection drug use). Over half (55%) indicated that their IDU had put them at risk of contracting HIV/AIDS or HCV. Most offenders (66%) said they worried about the threat of infectious diseases associated with IDU.

A recent history of IDU is more likely to be associated with moderate to severe drug dependency problems than a past history of IDU. Also, offenders in the Pacific Region had the highest prevalence of IDU, regardless of time period. These findings may have implications for the treatment of offenders, as the majority indicating recent IDU would require moderate or high intensity treatment.

Although offenders indicated being worried about the health risks associated with IDU, they continued to share injection equipment. Opioid use among offenders indicating recent IDU was evident. Both of these findings support the need for health education and strategies to ensure offenders are able to minimize the health risks of their substance use.

Skinner, H.A. (1982). The Drug Abuse Screening Test. Addictive Behaviours, 7, 363-371.

UNAIDS (2006). 2006 Report on the global AIDS epidemic. UNAIDS.

Zakaria, D., Thompson, J.M., Jarvis, A., & Borgatta, F. (2010). Summary of Emerging Findings from the 2007 National Inmate Infectious Diseases and Risk Behaviours Survey. Ottawa: Correctional Service Canada.

Zou. S., Tepper, M., & Guilivi, A. (2001). Viral hepatitis and emerging blood-borne pathogens in Canada. Canada Communicable Disease Report. 27S3.

Prepared by:

Shanna Farrell, Jonathan Ross, Marguerite Ternes, & Dan Kunic.

For more information

Addictions Research Centre
Research Branch
(902) 838-5900
addictions.research@csc-scc.gc.ca