Patterns of cocaine and opioid co-use and polyroutes of administration among street-based cocaine users in Montréal, Canada

• Published in: The International journal of drug policy 2013-03, Vol.24 (2), p.142-149
• Main Authors: Roy, Élise, Richer, Isabelle, Arruda, Nelson, Vandermeerschen, Jill, Bruneau, Julie
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Analgesics, Opioid - administration & dosage; Canada - epidemiology; Cocaine; Cocaine - administration & dosage; Drug Administration Routes; Drug policy; Drug use; Drug Users - psychology; Drug Users - statistics & numerical data; Effectiveness studies; Ethnic Groups - psychology; Ethnic Groups - statistics & numerical data; Female; Homeless Persons - psychology; Homeless Persons - statistics & numerical data; Humans; Internal Medicine; Male; Medical Education; Public health; Risk-Taking; Socioeconomic factors; Unsafe Sex - psychology; Unsafe Sex - statistics & numerical data
• ISSN: 0955-3959; 1873-4758
• DOI: 10.1016/j.drugpo.2012.10.004

Abstract Background Effective public health programs aimed at problematic cocaine users are challenged by the fact that they can have complex patterns of drug use with respect to polysubstance use and routes of drug administration. This study was carried out to explore the presence of subgroups of cocaine users on the basis of their concurrent use of opioids and their routes of cocaine and opioid administration, and to determine if subgroups could be differentiated in terms of sociodemographic factors and risk behaviours. Methods Regular cocaine users (≥1 per week) were recruited in low-threshold services located in the Montréal downtown area. The following variables were examined: demographic characteristics, types of drug used, routes of drug administration, and condom use with occasional or commercial sexual partners. Latent class analysis and multinomial logistic regression modeling were carried out. Results 886 cocaine users were recruited (83.5% male: mean age 35.38 years). A 5-class model was identified: (1) “cocaine smokers” (CSs) ( n = 161; membership probability (MP) = 0.183); (2) “cocaine smokers/sniffers” (CSSs) ( n = 201; MP = 0.218); (3) “cocaine injectors” (CIs) ( n = 207; MP = 0.231); (4) “cocaine-opioid injectors” (COIs) ( n = 277; MP = 0.291); (5) “cocaine-opioid polyroute users” (COPs) ( n = 40; MP = 0.077). Compared with COIs, other subtypes were significantly different in terms of either age, duration of cocaine use, ethnic background, homelessness, polydrug use or condom use. Conclusion The heterogeneity of consumption patterns supports the importance of offering an array of interventions aimed at problematic cocaine users. These should include the provision of clean injecting and smoking material, the promotion of safe sexual behaviours and the prevention of initiation to drug injection. In the absence of specific treatment, cocaine users should have access to primary health care services and addiction treatment based on innovative behavioural and pharmacological approaches.