Abstract
BACKGROUND: Harms associated with public drug injection in large cities are well-established, but little is known about challenges that public injecting may pose for smaller municipalities. We evaluated the prevalence and correlates of public injecting among a sample of people who inject drugs in London, a mid-sized city in southwestern Ontario. METHODS: Between March and April 2016, a sample of people who injected drugs participated in a quantitative survey as part of the Ontario Integrated Supervised Injection Services Feasibility Study. Bivariable and multivariable logistic regression models estimated associations of sociodemographic characteristics, sociostructural exposures and drug use behaviours with regular public injecting (injecting in public ≥ 25% of the time over the previous 6 mo). We also described the locations and rationales provided for public injecting. RESULTS: A total of 196 participants (38.3% female, median age 39 yr) provided complete data. Of the 196, 141 (71.9%) reported any public injecting in the previous 6 months, and 91 (46.4%) injected in public regularly. Homelessness or unstable housing (adjusted odds ratio [OR] 2.04, 95% confidence interval [CI] 1.01-4.12) and frequently injecting opioids (adjusted OR 2.27, 95% CI 1.17-4.42) or crystal methamphetamine (adjusted OR 2.38, 95% CI 1.18-4.79) daily were independently associated with regular public injection. Convenience (98 participants [69.5%]) and homelessness (56 [39.7%]) were the most commonly reported reasons for public injecting. INTERPRETATION: As in large cities in Canada, public injecting in London is common and appears to be associated with unstable housing and high-intensity injecting. These results indicate an urgent need to create safer environments for people who inject drugs in London, including supervised injection, to reduce the negative individual and community impacts of public injecting.