Trajectories of injection drug use among people who use drugs in Vancouver, Canada, 1996-2017: growth mixture modeling using data from prospective cohort studies

Addiction. 2019 Dec;114(12):2173-2186. doi: 10.1111/add.14756. Epub 2019 Aug 16.


Background and aims: Injection drug use patterns are known to change over time, although such long-term changes have not been well described. We sought to characterize longitudinal trajectories of injection drug use and identify associated factors.

Design: Data were derived from the Vancouver Injection Drug Users Study and AIDS Care Cohort to evaluate the Exposure to Survival Services study, two prospective cohorts involving people who inject drugs in Vancouver, Canada between 1996 and 2017. Growth mixture modeling was applied to identify distinct injection drug use trajectories. Multinomial logistic regression was used to identify baseline factors associated with each trajectory.

Setting: Canada.

Participants: A total of 2057 participants who reported having used illicit drugs via injection in the past 6 months at the baseline visit were included in the study. The median time since first injection drug use at baseline was 14.8 years (quartile 1-quartile 3: 6.5-24.3).

Measurements: Information regarding self-reported injection drug use during the past 6 months was collected at baseline and semi-annually thereafter via interviewer-administered questionnaires.

Findings: Participants were followed for a median of 113.4 months (quartile 1-quartile 3: 63.4-161.7). Five trajectories were identified: persistent high frequency injection (507, 24.6%); high frequency injection with late decrease (374, 18.2%); gradual cessation (662, 32.2%); early cessation with late relapse (227, 11.0%); and early cessation (287, 14.0%). Factors found to be associated with distinct trajectories included: daily heroin injection, binge injection drug use, age, not being in a stable relationship and year of study enrollment.

Conclusions: People who used drugs in Vancouver, Canada from 1996 to 2017 appeared to follow five drug use trajectories, ranging from persistent high frequency use to early cessation. Almost 25% of participants remained high-frequency injectors over the study period.

Keywords: Cessation; growth mixture modeling; injection drug use; latent trajectory groups; longitudinal studies; relapse.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Canada / epidemiology
  • Drug Users / statistics & numerical data*
  • Female
  • Humans
  • Illicit Drugs*
  • Latent Class Analysis
  • Male
  • Models, Statistical*
  • Prospective Studies
  • Self Report
  • Substance Abuse, Intravenous / epidemiology*


  • Illicit Drugs