The impact of social, structural and physical environmental factors on transitions into employment among people who inject drugs

► We assess factors predicting transitions into employment among a cohort of injection drug users in Vancouver, Canada. ► Analyses consider different substances and high-intensity patterns of use, as well as features of the broader risk environment. ► The impact of high-intensity drug use on work uptake is conditioned by exposure to social, physical and structural risk. ► Structural vulnerability and risk environments strongly shape labour market outcomes over and above drug use practices. ► Interventions to improve employment should seek to address social, structural and physical aspects of the risk environment.