| Summary: | Background: Given the limited understanding of the epidemiology of methamphetamine (MA) use among street-involved youth and injection drug users (IDU), this thesis sought to: systematically characterise the evidence base demonstrating associations between MA use and adverse health outcomes among young people; examine the incidence and predictors of MA injection initiation among a cohort of IDU in Vancouver; describe the prevalence and correlates of MA use among sexual minority drug users; determine whether frequent MA injection predicts emergency department (ED) utilisation; and finally, explore the pathways through which MA use drives injection-related risk behaviour including syringe sharing.
Methods: Street-involved youth and IDU participating in three open prospective cohort studies were asked to complete semi-annual interviewer-administered questionnaires, provide blood samples for HIV testing, and consent to hospital database linkages. A variety of longitudinal techniques were used to investigate the association between self-reported MA-related outcomes (e.g., initiation, frequent use) and individual, social, and structural determinants of interest.
Results: A systematic review identified consistent associations between MA use and a number of health outcomes, including depression, suicidal ideation, and psychosis. Scientific evidence to suggest an association between MA use and a number of previously suggested harms (e.g., infectious disease transmission, dental problems) is equivocal. Some subpopulations, including sexual minority drug users, are more likely to use MA, which appears to exacerbate exposure to HIV-related risks and other vulnerabilities. Longitudinal analysis revealed that young people, non-injection stimulant users, homeless individuals, and those involved in the city’s open drug scene are most likely to initiate MA injection. The injection of MA, particularly frequently, was associated with a number of health and behavioural outcomes, including an increased hazard of ED utilisation and syringe sharing. Barriers to accessing harm reduction and HIV prevention services likely account for many of these relationships.
Conclusions: Methamphetamine use is increasingly common among street youth and IDU in Vancouver. Its use and resultant harms appear to be driven by intersecting individual, social, and structural factors. Comprehensive interventions that are based upon sound scientific evidence and that address existing health and social inequities among marginalised populations are required. === Medicine, Faculty of === Population and Public Health (SPPH), School of === Graduate
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