Rationale for PRIMER
Our goal is to understand the role that people who inject drugs play in initiating others into injection drug use. Here you can read about why we are doing this and how we plan to do it.
Rationale for PRIMER
Our goal is to understand the role that people who inject drugs play in initiating others into injection drug use. Here you can read about why we are doing this and how we plan to do it.
Background
The primary goal of PRIMER is to learn about how different health programs and policies aimed at people who inject drugs (PWID) can reduce the rate at which new people start injecting as part of their drug use. We have learned that PWID tend to play an important role in helping other people transition into injection drug use. Injecting drugs is one of the main ways that HIV and Hep-C are currently spread. Concurrently, there is a problematic gap in healthcare when it comes to preventing the transition into injection drug use from non-injection drug use. Therefore we believe that programs aimed at helping PWID live healthier lives may also reduce the risk that they will help other people start using injection dugs. With this knowledge, we can create and design approaches that better improve the health of PWID as well as the health of those who are at risk of injecting.
Methodology
PRIMER is a mixed-methods study, taking place in many cities around the world. In order to achieve our main research goal, PRIMER has been divided into four tasks. The first is to investigate PWID helping others to begin injecting. The second is to identify factors (such as age and gender) that affect the chances that PWID will help others begin to inject drugs. The third is to describe different roles that PWID may play (such as being a drug dealer) and how these roles impact the chances that they help someone start to inject. The last is to measure the impact of different programs and policies on whether PWID help others to start injecting. This will all be done by pooling observational data from Vancouver, Canada, San Diego, USA, Tijuana, Mexico, and Paris, Marseille, and Bordeaux, France.
Results
The PRIMER team is conducting a prospective, mixed-methods study of PWID (n = 3050) in four separate cohorts of PWID across North America and France (San Diego, STAHR II; Tijuana, El Cuete IV; Vancouver, V-DUS; Bordeaux, Marseille, Paris and Strasbourg, COSINUS).
Conclusions
PRIMER is the world’s largest study on injection initiation. It is the first study to investigate structural approaches to preventing initiation into injection drug use. Findings can be used to inform the design of new programs and policies aimed at preventing injection drug use.
Documentary
Learn about Dr. Dan Werb and PRIMER in this 13 minute documentary presented by the CBC (Canadian Broadcasting Corporation).
Findings
The results of the PRIMER study can improve future efforts to prevent injection drug use. These findings can inform the creation and design of interventions, policies, and structural approaches to combatting both injection drug use and its related harms. Here you can browse PRIMER publications and download PDF versions of the articles.
Findings
The results of the PRIMER study can improve future efforts to prevent injection drug use. These findings can inform the creation and design of interventions, policies, and structural approaches to combatting both injection drug use and its related harms. Here you can browse PRIMER publications and download PDF versions of the articles.
Featured Publications
Meyers SA, Scheim A, Jain S, Sun X, Milloy MJ, DeBeck K, Hayashi K, Garfein RS, Werb D
This study sought to determine how gender may shape the risk that people who inject drugs help others initiate drug injecting. It collected data from three different settings: San Diego, USA; Tijuana, Mexico; and Vancouver, Canada.
Guise A, Horyniak D, Melo J, McNeill R, Werb D
Qualitative research shows that starting to inject drugs has a range of distinct meanings – pleasure, increasing tolerance, securing belonging, coping with pain – and is shaped by the environments in which people live.
Hamida AB, Rafful C, Jain S, Sun S, González-Zúñiga P, Rangel G, Strathdee SA, Werb D
There are 12 million people worldwide who inject drugs; of which 1.6 million are living with HIV and 6 million are living with hepatitis C.
Melo JS, Mittal ML, Horyniak D, Strathdee S, Werb D
This review aims to characterize the risk factors for injection drug use initiation associated with migration and describe how these might be addressed through interventions.
Melo JS, Garfein RS, Hayashi K, Milloy MJ, DeBeck K, Sun S, Jain S, Strathdee SA, Werb D
Experts suggest that preventing injection initiation is likely to be more effective in reducing disease incidence than seeking to reduce risks experienced by individuals after they initiate injection.
Mittal ML, Vashistha D, Sun S, Jain S, Cuevas-Mota J, Garfein RS, Strathdee S, Werb D
This study highlights the need to further investigate the potential impact of Medication-assisted treatment (MAT) as a preventive intervention to reduce not only the incidence of negative injection-related health outcomes experienced by opioid users but also incident cases of IDU initiation.
Rafful C, Melo J, Medina-Mora ME, Rangel G, Sun S, Jain S, Werb D
Efforts to prevent injection drug use (IDU) are increasingly focusing on the role that people who inject drugs (PWID) play in facilitating the entry of others into this behavior.
Publications List
- Drugs, discipline and death: Causes and predictors of mortality among people who inject drugs in Tijuana, 2011-2018.
- Prevalence and Correlates of Providing and Receiving Assistance with the Transition to Injection Drug Use.
- Impact evaluations of drug decriminalisation and legal regulation on drug use, health and social harms: a systematic review.
- Where Is the Opioid Use Epidemic in Mexico? A Cautionary Tale for Policymakers South of the US-Mexico Border.
- "Another Person Was Going to Do It": The Provision of Injection Drug Use Initiation Assistance in a High-Risk U.S.-Mexico Border Region.
- Prevalence and correlates of selling illicit cannabis among people who use drugs in Vancouver, Canada: A ten-year prospective cohort study.
- Expanding access to diacetylmorphine and hydromorphone for people who use opioids in Canada.
- Evaluating networked drug checking services in Toronto, Ontario: study protocol and rationale.
- Guidelines for public health and safety metrics to evaluate the potential harms and benefits of cannabis regulation in Canada.
- Opioid agonist treatment scale-up and the initiation of injection drug use: A dynamic modeling analysis.
- The role of gender and power dynamics in injection initiation events within intimate partnerships in the US-Mexico border region.
- Navigating social norms of injection initiation assistance during an overdose crisis: A qualitative study of the perspectives of people who inject drugs (PWID) in Vancouver, Canada.
- Opioid agonist treatment and the process of injection drug use initiation.
- Identification of a Syndemic of Blood-Borne Disease Transmission and Injection Drug Use Initiation at the US-Mexico Border.
- Comparing risk environments for HIV among people who inject drugs from three cities in Northern Mexico.
