Drug Dealing Involvement Among People Who Inject Drugs in Colombia: Prevalence, Demographics and Injection Risk Correlates.

Introduction: Latin America accounts for one of the largest populations of people who inject drugs (PWID) in the world, with Colombia reporting one of the fastest growing populations of PWID in the region. Additionally, PWID in the country are highly exposed to the drug market and drug dealing networks. However, a correlation between PWID and drug dealing involvement has not been described. Therefore, the aim of this study is to analyze the demographics and injection practices of drug-dealing PWID in Colombia.

Methods: A cross-sectional study involving 1,099 PWID recruited by Respondent Driven-Sampling in five Colombian cities was conducted between January and June of 2014. An adapted version of the Behaviors of High Risk Drug Consumers Survey (CODAR by its Spanish acronym) was administered to each participant. Correlates of demographic characteristics, drug dealing involvement and injection behaviours were examined through a binary logistic regression model and multivariate analysis.

Results: Participants were predominantly male (86%) with a mean age of 26 years. Fifty-six percent of participants –of whom 64% had low familial socioeconomic status- had been involved in drug dealing in the previous six months. Compared to non-drug-dealing PWID, drug-dealing PWID reported higher odds of: drug dealing or other illegal activity as primary income source (AOR: 3.2; CI: 1.5-6.8; p>0.001), injection rate of four or more times daily (AOR: 1.3; CI: 1.0-1.7; p=0.04), injection equipment confiscation by the police (AOR: 1.4; CI: 1.0-1.8; p=0.02), having ever suffered a heroin or opium overdose (AOR: 1.4; CI 1.1-2.0; p=0.01) and having given or sold used syringes to other PWID over the prior six months (AOR: 1.4; CI 1.0-1.8; p=0.02). Moreover, drug-dealing PWID were less likely to self-pay for the drug they injected (AOR: 0.6; CI: 0.4-0.9; p=0.01).

Conclusions: Involvement of Colombian PWID in drug dealing was higher than previously reported. The described specific socio-demographic vulnerabilities and risky injection behaviours identified in drug-dealing PWID, along with a better understanding of the complex economic, social and cultural factors leading to drug dealing in the country, may set the ground for further effective design and implementation of structural and personalized policies aiming to decrease drug dealing involvement as well as increase harm reduction and consumption prevention strategies for drug-dealing PWID and their consumption networks.