Global data on young people who inject drugs suggests harm reduction approaches should be scaled up
Injecting drug use is a global issue: around the world an estimated 15.6 million people inject psychoactive drugs. People who inject drugs tend to begin doing so in adolescence. Countries that have larger numbers of adolescents who inject drugs may be at risk of emerging epidemics of blood borne viruses unless they take urgent action.
About the research
People who inject drugs may expose themselves to multiple health risks including addiction, blood-borne viruses, and overdose, and are often stigmatised. New generations of young people are starting to inject drugs, and young people who inject drugs are often part of other vulnerable groups1.
Research into the causes of injecting drug use tends to focus on individual factors. We wanted to explore the effect of global development on the age distribution of people who inject drugs. A recent systematic review showed wide country-level variation in the number of young people who comprise the population of people who inject drugs1. By considering variation in countries, we hoped to be able to inform prevention and intervention efforts.
Through a global systematic review and meta-analysis we aimed to find data on injecting drug use in published studies, public health and policy documents from every country. We used these data to estimate the global percentage of people who inject drugs that are aged 15-25 years old, and also estimated this for each region and country. We mapped this against data from the World Bank that identified markers of a country’s wealth, equality, and development.
• More countries should scale up access to harm reduction interventions (such as needle and syringe exchange programmes and opioid substitution therapy) to the levels recommended by the World Health Organisation.
• Global policymakers should consider population health, and especially mental health, alongside urban development to address evidence that countries with higher urbanisation growth are seeing new, older populations beginning to inject drugs.
• Ministries of Health in low- and middle-income countries should be supported to collect accurate data on levels of injecting drug use across the life span, and use that data to inform public health and policy.
• Our study2 estimated that, globally, around a quarter of people who inject drugs are adolescents and young adults and approximately 3.9 million young people inject drugs. As a global average, people start injecting drugs at 23 years old.
• We found huge variation in the percentage of young people in each country’s population of people who inject drugs. Regionally, Eastern Europe had the highest proportion of young people amongst their populations who inject drugs (43%), and the Middle Eastern and North African region had the lowest (7%). In both Russia and the Philippines, over 50% of the people who inject drugs were aged 25 or under, and the average age of the populations of people who inject drugs was amongst the lowest observed.
• In relation to global development indicators, people who inject drugs were younger in countries with lower wealth (indicated through Gross Domestic Product per capita) and had been injecting drugs for a shorter time period.
• In rapidly urbanising countries (indicated through urbanisation growth rate) people were likely to start injecting drugs at later ages than people in countries with a slower current rate of urbanisation. It may be that changes in environment are providing opportunities for injecting drug use that people hadn’t previously had. It’s estimated that almost 70% of the global population will live in urban areas by 2050, with most of this growth driven by low and middle-income countries.
• We didn’t find any relationships between the age of people who inject drugs and a country’s youth unemployment, economic equality, or level provision of opiate substitution therapy.
• Despite the health risks of injecting drug use, and the urgent need to reduce risks for new generations, our study has revealed a paucity of data monitoring this behaviour, which could affect these results. Most concerning, we know the least about youth injecting drug use in low- and middle-income countries: areas likely to have the highest numbers of young people in their populations of people who inject drugs.
This study was partly funded by the Australian National Drug and Alcohol Research Centre (University of New South Wales). Lindsey is supported by a Sir Henry Wellcome Postdoctoral Fellowship from the Wellcome Trust.
1 Degenhardt, L., Peacock, A., Colledge, S., Leung, J., Grebely, J., Vickerman, P., Stone, J., Cunningham, E.B., Trickey, A., Dumchev, K. and Lynskey, M., 2017. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. The Lancet Global Health, 5(12), pp.e1192-e1207.
2 Hines, L.A., Trickey, A., Leung, J., Larney, S., Peacock, A., Degenhardt, L., Colledge, S., Hickman, M., Grebely, J., Cunningham, E.B. and Stone, J., 2020. Associations between national development indicators and the age profile of people who inject drugs: results from a global systematic review and meta-analysis. The Lancet Global Health, 8(1), pp.e76-e91.
Larney et al (2017) Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review. https://doi.org/10.1016/S2214-109X(17)30373-X
We are currently undertaking work to explore the impact of Covid-19 on the drug use and health of PWID:
Dr Lindsey Hines and Dr Adam Trickey, University of Bristol
Policy Briefing 85: June 2020
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