Local drug - crime dynamics in a Canadian multi-site sample of untreated opioid users.

• Author: Manzoni, Patrik

Introduction

Past research has well documented that illicit drug users tend to be engaged in criminal activities as a revenue source (McBride and McCoy 1993; White and Gorman 2000). As one theoretical perspective on the link between drug use and crime, Goldstein (1985) presumed that an obvious factor contributing to illicit drug users' criminal engagement is pharmacological and economic need related to the extent of their drug consumption. Regular drug use is most likely to facilitate tolerance and dependence, and hence increasing financial resources are needed in order to cover the costs of drug consumption. To generate income, drug users may engage in a variety of criminal activities, such as committing some sort of property crime (e.g., theft, burglary, fraud), getting involved in the trade or distribution of illegal substances, or--mostly for women--generating proceeds from sex work. Regarding illicit opioid users' income-generating activities, international research has pointed to degrees of criminal involvement that vary considerably both within national samples and across (Johnson, Goldstein, Preble, Schmeidler, Lipton, Spunt, and Miller 1985; Dobinson and Poletti 1988; Parker, Bakx, and Newcombe 1988; Uchtenhagen, Dobler-Mikola, Steffen, Blattler, and Pfeifer 1999; Cross, Johnson, Davis, and Liberty 2001; Maher, Dixon, Hall, and Lynskey 2002).

In a review of studies on patterns of income-generating behaviours among heroin users from the United States, Europe, and Australia, Maher et al. (2002) showed that, typically, a majority of user populations were involved in property crime, with the exceptions of a Norwegian (Bretteville Jensen and Sutton 1996) and an Australian sample (Dobinson and Poletti 1988), where about a quarter reported property crime. The proportion of heroin users who reported drug dealing ranged from 11% to 100% and about the same range of variation could be observed in the proportion of users who received funds through legal income. More specifically, in the seminal study of Johnson et al. (1985) of 202 New York heroin users drawn from the community, 23% reported illicit drug-market activities and 44% some form of property crime. In a more recent study from Baltimore, Kinlock, O'Grady, and Hanlon (2003) found that, within a sample of 188 predominantly heroin-using offenders, 52% committed theft and 85% reported drug selling. Studies by Parker and various colleagues (Jarvis and Parker 1989; Parker et al. 1988), based on samples of about 100 heroin users from North England, documented high involvement in property crime (64-74%) but relatively low rates of drug dealing (11-20%). In Sydney, Australia, Maher, Dixon, Lynskey, and Hall (1998) showed that, of a community sample of 202 daily heroin users, 70% reported property crimes and 70% drug dealing. Conversely, Dobinson and Poletti (1988) found a relatively low prevalence rate of property crime but involvement in illicit drug selling in all participants of their community sample of 129 heroin users also from New South Wales (Australia). Thus, these examples illustrate that there is considerable heterogeneity in illicit opioid users' criminal involvement in terms of both the nature and the extent of the crimes they engage in.

Still, little is known of the nature of associations between criminal activities and illicit drug use in Canada. A large study of Canadian inmates and arrestees assessed those criminal offences associated with alcohol and drug use (Pernanen, Cousineau, Brochu, and Sun 2002). It was found that about half of the offenders had used illicit drugs (43% marijuana, 7% heroin, 23% cocaine) in the six months before their last arrest, and 31% were defined as dependent on one of these illicit drugs by the Drug Addiction Severity Test. Further, it was estimated that about 10-15% of the rather serious offences committed by imprisoned offenders could be attributed to illicit drug use.

Another study was based on an opioid users' sample drawn from the community in Toronto and found the majority to be highly involved in crime and the criminal justice system (Fischer, Medved, Gliksman, and Rehm 1999). For example, 47% of the sample had committed a property crime and 68% had been involved in drug dealing in the 30 days prior to assessment.

A large cohort study of opioid users outside of treatment included information on drug use and income-generating behaviours in five Canadian cities, thus providing an opportunity for a systematic comparison of the extent and prediction of criminal activities in this sample. Previous analyses pointed to substantial differences in key characteristics of drug use and other health-related issues for the local study samples in different cities (Fischer, Rehm, Brissette, Brochu, Bruneau, El Guebaly, Noel, Tyndall, Wild, Mun, and Baliunas 2005).

Against this background, the aim of the present study is twofold: first, to examine the extent of criminal involvement and the drug-use patterns in each study site; second, to explore what factors are associated with specific crimes and whether those factors have a different impact within specific local study sites. In our attempt to explore local dynamics contributing to involvement in criminal activities, we focused on the key factors of drug use and the socioeconomic and demographic characteristics of illicit opioid users. Regarding drug use, the majority of pertinent studies clearly showed a higher involvement in crime (i.e., property crime and/or drug dealing) during periods of high opioid use and decreases during periods of abstinence (e.g., Ball, Rosen, Flueck, and Nurco 1981; Anglin and Speckart 1988; Jarvis and Parker 1989; Deschenes, Anglin, and Speckart 1991; Nurco 1998). There is evidence from both the United States and England that the same dynamic may be true for other illicit substances that most opioid users consume, namely cocaine and especially crack (Collins, Hubbard, and Rachal 1985; Johnson et al. 1985; Hunt 1991; Inciardi and Pottieger 1994; Miller and Gold 1994; Best, Sidwell, Gossop, Harris, and Strang 2001; Gossop, Marsden, Stewart, and Kidd 2002). Further, the extent of drug users' criminal involvement is related to their socio-economic situation, expressed as low legal income or poor housing. Regular illicit drug use and addictive behaviour are often accompanied by processes of marginalization, and so affected drug users are largely excluded from legal income sources and hence are more likely to engage in illegal activities (Cross et al. 2001; Erickson, Butters, and German 2002). We further controlled by gender. It is well known from the literature that men are typically much more likely to engage in crime than women (Steffensmeier and Allan 1996) and that female drug users are more likely to engage in sex work (Bretteville Jensen and Sutton 1996). Regarding female drug users' involvement in property crime, there is mixed empirical evidence. While some studies found female users to be less likely to be involved (Bretteville Jensen and Sutton 1996; Grella 2003), others suggested no gender differences (Maher et al. 2002; Stewart, Gossop, Marsden, Kidd, and Treacy 2003).

The acquisitive crimes of opioid users continue to burden societies with harms that translate into substantial social costs--mostly due to the costs of their involvement in the criminal justice system and of the victimization of citizens (Single, Robson, Xie, and Rehm 1996; Rajkumar and French 1997; Healey, Knapp, Astin, Gossop, Marsden, Stewart, Lehmann, and Godfrey 1998; Wall, Rehm, Fischer, Brands, Gliksman, Stewart, Medved, and Blake 2000). In order to prevent social harms related to the criminal activities of illicit drug users, empirical knowledge not only of the extent of acquisitive crime but also of the factors associated with crime will be useful. On this basis, evidence for local prevention efforts can be provided.

National and local context of illicit drug use

The link between criminal activities and drug use is complex and is influenced by a number of factors, including drug markets (e.g., availability and price of a drug; see, e.g., Caulkins and Reuter 1996), legal income opportunities, and policing or other aspects of public policy (Johnson, Maher, and Friedman 2001). Although a detailed assessment of these contextual factors for Canada is beyond the scope of this article, it should be helpful to give the reader some basic information on illicit drug use in the study sites as well as on Canada's drug policy and treatment situation.

It is estimated that Canada is home to between 75,000 and 125,000 people who inject drugs such as heroin, cocaine, or amphetamines (Single 2000). Most of the estimated 60,000-90,000 illicit opioid users (Fischer and Rehm 1997) live in one of the three big cities of Toronto (4.7 million inhabitants), Montreal (3.4 million), and Vancouver (2 million) (Kuo, Fischer, and Vlahov 2000). The overwhelming majority of today's illicit opioid users can be characterized as poly-drug users who are co-using a variety of substances, such as cocaine, crack, amphetamines, and benzodiazepines (Canadian Community Epidemiology Network on Drug Use 2003; Fischer, Monga, and Manzoni 2005). Despite the considerable diversity regarding illicit drug-use patterns, key characteristics of our study sites were described in the literature.

A unique feature of Vancouver is the drug scene concentrated in the Downtown Eastside area. Along with other substances, its drug users mostly inject heroin, which is abundant there (Buxton 2003). Conversely, reports from Edmonton (1 million inhabitants) state that the availability of heroin is limited and that the injection of cocaine or prescription opioids is, therefore, more common among injection drug users (Wild, Prakash, O'Connor, Taylor, Edwards, and Predy 2003). Two features that are typical of Toronto street drug users are the widespread popularity of crack cocaine, which is predominantly smoked, and a...