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Argento E, Shannon K, Fairbairn N, Moreheart S, Braschel M, Goldenberg S. Increasing trends and incidence of nonfatal overdose among women sex workers who use drugs in British Columbia: The role of criminalization-related barriers to harm reduction. Drug Alcohol Depend 2023; 244:109789. [PMID: 36753803 PMCID: PMC10773461 DOI: 10.1016/j.drugalcdep.2023.109789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Structurally marginalized women who use drugs experience disproportionately elevated health and social inequities that require specialized responses to mitigate risk of overdose. This study aimed to longitudinally investigate incidence and predictors of first nonfatal overdose among women sex workers who use drugs. METHODS Data (2010-2019) were drawn from AESHA (An Evaluation of Sex Workers Health Access), a community-based, prospective, open cohort of > 900 women sex workers in Metro Vancouver, Canada. Incidence was examined and Cox regression modelled time-updated predictors of first nonfatal overdose. Time series analysis examined annual trends. RESULTS Among 273 eligible participants, 23% (n = 63) reported a first nonfatal overdose over follow-up with an incidence density of 5.87/100 person-years. In multivariable analysis, independent predictors of time to nonfatal overdose were police-related barriers to harm reduction (Adjusted Hazard Ratio [AHR]=2.62; 95% confidence interval [CI] 1.51-4.54), binge alcohol use (AHR=2.28; 95%CI 1.16-4.45), opioid use (AHR=2.23; 95%CI 1.15-4.33), and crystal methamphetamine use (AHR=2.07; 95%CI 1.27-3.39). Time series analysis demonstrated a significantly increasing trend in first nonfatal overdose, with annual proportions increasing 0.59% (95%CI 0.39-0.78%) every year, on average. CONCLUSIONS This study provides strong longitudinal evidence from the longest-standing cohort of sex workers in North America. Nonfatal overdose in this setting is a critical public health concern. Criminalization-related barriers to harm reduction strongly predicted nonfatal overdose. Structural changes to legal and policing practices alongside gender-sensitive addiction services are urgently needed.
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Affiliation(s)
- Elena Argento
- Department of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada; BC Centre on Substance Use, 1045 Howe St., Vancouver, BC V6Z 1Y6, Canada; Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada
| | - Kate Shannon
- Department of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada; Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada; BC Centre on Substance Use, 1045 Howe St., Vancouver, BC V6Z 1Y6, Canada
| | - Sarah Moreheart
- Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada
| | - Shira Goldenberg
- Department of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada; Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, USA.
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Victor G, Sightes E, Watson DP, Ray B, Bailey K, Robision L, Fears G, Edwards R, Salyers M. Designing and implementing an intervention for returning citizens living with substance use disorder: discovering the benefits of peer recovery coach involvement in pilot clinical trial decision-making. JOURNAL OF OFFENDER REHABILITATION 2021; 60:138-158. [PMID: 33551628 PMCID: PMC7861566 DOI: 10.1080/10509674.2020.1863301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Peer-facilitated services in behavioral health care remain underutilized within criminal justice-involved community organizations, and there is little guidance for how to best involve peer workers in behavioral health-focused research activities. This paper described lessons learned regarding implementation of peer recovery coaches (PRCs) as part of development and pilot research on Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT), a peer-facilitated substance use disorder (SUD) intervention for returning citizens. Qualitative data were collected from learning meetings with key stakeholders and group interviews with SUPPORT clinical trial participants and PRCs. Transcripts were analyzed to identify key decisions made impacting the development, implementation, and/or revision of the SUPPORT intervention and pilot clinical trial protocols. Analysis demonstrated that PRC involvement drove many of the decisions made regarding modifications to the original intervention and trial protocols, while benefitting client-level interactions and by influencing the non-profit agency and its connection to stakeholders. Moreover, PRCs improved the research design by refining the incentive structure and data collection plans. PRC involvement also contributed to the development of more recovery-oriented resources and catering support services to the unique needs of justice-involved individuals. Discussed were the implications for the role of PRCs in justice-involved behavioral health research and treatment.
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Affiliation(s)
- Grant Victor
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202
| | - Emily Sightes
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202
| | - Dennis P Watson
- Lighthouse Institute, Chestnut Health Systems, 1003 Martin Luther King Jr Dr, Bloomington, IL 61701
| | - Bradley Ray
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202
| | - Katie Bailey
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202
| | - Lisa Robision
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, 818 S. Wolcott, Chicago, IL 60612
| | - Gina Fears
- Public Advocates in Community re-Entry, 2855 N. Keystone Ave., Indianapolis, IN 46218
| | - Rhiannon Edwards
- Public Advocates in Community re-Entry, 2855 N. Keystone Ave., Indianapolis, IN 46218
| | - Michelle Salyers
- Departement of Psychology, 402 N. Blackford St., Indianapolis, IN 46202
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