Barriers to safer injection practices faced by people who use intravenous drugs, in Vancouver and Abbotsford, B.C.

Abstract

Abstract

Objective Obstacles are often put in place to discourage users of injection drugs from using public facilities to inject.  These include frequent security patrols, locked washroom facilities, and the installation of blue lights designed to obstruct the visualization of veins.  Unfortunately, some of these interventions may have the unintended consequence of increasing the risks inherent to injecting drugs.  We discuss a number of these barriers and argue that these barriers should be addressed to mitigate these risk factors.

Methods We interviewed 18 individuals who were previous or current users of injection drugs with the goal of discussing the placement of blue lights in public washrooms and the impact this may have on limiting their ability to safely inject.

Results Interviewees informed us of numerous factors that were involved in selecting a location to inject.  These factors influenced their comfort level and, consequently, influenced the speed and ease with which they would inject.  Factors that negatively influenced comfort tended to increase the likelihood of missing veins and requiring multiple tries.  These factors included: person related factors, such as the presence of authority figures or uninvolved members of the public; environmental factors, such as the level of light and temperature; and personal issues such as the depth, size or condition of veins.

Conclusions While harm reduction education and the discussion of intentional barriers to the safe use of injection drugs are certainly beneficial, there are numerous physical and societal obstacles that prevent users of injection drugs from using their preferred, often safer methods.