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Although public injecting has been studied in large urban centres, little is known about the factors that drive public injecting in remote communities. This study sought to explore public and semi-public injection in Thunder Bay, a remote and mid-sized city in Northwestern Ontario. Peer researchers completed surveys with people who inject drugs. Multivariable logistic regression was used to examine sociodemographic characteristics and behavioural patterns associated with injecting in public or semi-public settings. Among 200 people who inject drugs, 128 (64%) individuals reported engaging in public injection. In multivariable analyses, public injecting was positively associated with age (Adjusted Odds Ratio [AOR], 0.97, 95% Confidence Interval [CI]: 0.97–1.00;  p  = 0.05), homelessness (AOR 2.34, 95% CI: 1.10–5.02;  p  = 0.02), sex work (AOR 4.62, 95% CI: 1.37–21.61;  p  = 0.02), injecting alone (AOR 2.66, 95% CI: 1.19–6.02;  p  = 0.01), opioid injecting (AOR 3.64, 95% CI: 1.48–9.41;  p  = 0.05) and cocaine injecting (AOR 4.35, 95% CI: 2.11–9.44). The most frequent reasons for public injecting were proximity to where people buy drugs (59.4%), being too far from home (27.3%), and being homeless (25.8%). Our findings suggest that the scale-up of additional harm reduction programming in Thunder Bay, including supervised injection services, may address public injecting and reduce associated harms in this setting.

Public and semi-public injection drug use in Thunder Bay, Ontario: the case for supervised injection services