Binge Drug Injection Among People Who Inject Drugs in Montreal: Characterizing the Substances and Social Contexts Involved to Inform Prevention Efforts

Author: Nanor Minoyan Stine Bordier Høj Didier Jutras-Aswad Dragos Vlad Valérie Martel-Laferrière Marie-Pierre Sylvestre Julie Bruneau

Theme: Epidemiology & Public Health Research Year: 2022

High-intensity episodes of drug injection, or “binges”, may be important and under-considered drivers of
overdose and HCV transmission. We sought to describe binge drug injection episodes among PWID in
Montreal, Canada.
Data were drawn from the HEPCO cohort, which involves three-monthly interviews with active PWID.
At each visit (2010-2017), participants reported whether they had recently injected large quantities of
drugs over sustained periods until unable to continue (“binged”). Bingers provided additional details
about typical episodes (substances, injection frequency, persons present). Descriptive analyses were
805 participants (82% male, median age 41) provided 8158 observations. A recent binge was reported
during 590 visits, with 62% of bingers reporting engaging in this practice ≥ once/month. Various
substances were injected during binges: 21% heroin, 26% other opioids, 73% cocaine, 8% amphetamines
(non-mutually-exclusive). 76% (n=448) of bingers reported typically injecting a single substance: heroin
injectors reported a median 8 [Q1-Q3: 4-15] injections/episode, while those injecting other opioids
reported a median 12 [Q1-Q3: 8-30] injections/episode. Cocaine & amphetamine binges both involved a
median of 20 injections. Polysubstance binges (n=139) most commonly involved cocaine with heroin
(31%) or other opioids (48%). 63% of bingers reported additional use of ≥1 non-injection drug (most
frequently: alcohol [45%], marijuana [44%], crack [37%]) during binges. 35% of bingers reported
bingeing alone most of the time, with the remaining injecting most often with close friends (34%), casual
friends/acquaintances (28%), romantic/sexual partners (22%) or drug consumption partners (15%).
Those bingeing alone reported a similar number of injections to those injecting with others.
Binge injection episodes involve a diverse range of substances and social contexts. Given that naloxone
administration is an interpersonal practice, distribution efforts should aim to reach a broad profile of
PWID, regardless of opioid use history. The high proportion of individuals bingeing alone is concerning
and warrants additional outreach efforts.
Disclosure of Interest Statement:
No author has financial or personal relationships with people or organizations that could inappropriately
influence their work. SBH receives part of her salary from a Canadian Institutes of Health Research grant.
VML holds research grants from Gilead Sciences and Merck and receives advisor fees from Abbvie
(unrelated to the current work). DJA receives study material from Insys Therapeutics for a trial unrelated
to the current work. JB receives research grants from Gilead Sciences and Abbvie and receives advisor
fees from Gilead Sciences and Abbvie (unrelated to the present work).

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