Drug injection among street youth: the first time.

AIMS To describe the circumstances of the first drug injection among street youth. DESIGN A cohort study conducted in 1995-2000. PARTICIPANTS Subjects aged 14-25 years old were recruited in all major Montreal organizations offering free services to street youth. MEASUREMENT Subjects who reported having ever injected drugs completed questions on the circumstances of their first injection (calendar time, location, type of relationship with the initiator, presence of others, drug first injected, source of needle and use of clean needle and other injection materials). Questions on characteristics of the initiator and prior use of the first injected drug were added during the course of the study. FINDINGS Of 980 participants, 530 (54%) had ever injected drugs. Questionnaires were completed by 505 subjects, including 77 who also answered the additional questions. The mean age at first injection was 17.7 years. First injection occurred mainly in public places (41%). It was performed by a close friend (41%), the youth himself/herself (27%), an acquaintance (15%), a lover (10%) or another person (7%). Overall, 84% of youth first injected with a clean needle; only 62% used clean drug preparation equipment. The first drug injected was generally cocaine (47%) or heroin (41%). Two-thirds (53/77) had used the drug of first injection previously; however, the majority was not dependent upon it. CONCLUSIONS Most street youth used clean needles at first injection, but use of other clean injection materials was less frequent. Factors other than dependence appear to play a significant role in initiation into injection.