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Rolová G, Eide D, Gabrhelík R, Odsbu I, Clausen T, Skurtveit S. Gender differences in physical morbidity in opioid agonist treatment patients: population-based cohort studies from the Czech Republic and Norway. Subst Abuse Treat Prev Policy 2023; 18:47. [PMID: 37507709 PMCID: PMC10385939 DOI: 10.1186/s13011-023-00557-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Physical diseases represent a significant burden for opioid agonist treatment (OAT) patients. This study described physical morbidity in two national cohorts of OAT patients focusing on gender differences. METHODS This population-based cohort study linking multiple health registers investigated physical diseases (ICD-10) in patients receiving OAT in the Czech Republic (N = 4,280) and Norway (N = 11,389) during 2010-2019. Gender-stratified analysis was performed. RESULTS Overall, we found a large burden of physical morbidity across gender groups in OAT patients. In the Czech Republic and Norway, women in OAT had a significantly higher prevalence of physical diseases across most diagnostic chapters, notably genitourinary diseases and neoplasms. Injuries/external causes and infectious/parasitic diseases were among the most common diseases in both women and men. Viral hepatitis accounted for over half of infectious morbidity in women and men in both cohorts. CONCLUSIONS Our findings support the need for early screening, detection, and treatment of diseases and conditions across organ systems and the integration of health promotion activities to reduce physical morbidity in OAT patients. The gender differences underline the need for a tailored approach to address specific medical conditions.
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Affiliation(s)
- Gabriela Rolová
- First Faculty of Medicine, Department of Addictology, Charles University, Prague, Czech Republic.
- Department of Addictology, General University Hospital, Prague, Czech Republic.
| | - Desiree Eide
- University of Oslo, Norwegian Centre for Addiction Research, Oslo, Norway
| | - Roman Gabrhelík
- First Faculty of Medicine, Department of Addictology, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital, Prague, Czech Republic
| | - Ingvild Odsbu
- First Faculty of Medicine, Department of Addictology, Charles University, Prague, Czech Republic
- Norwegian Institute of Public Health, Oslo, Norway
| | - Thomas Clausen
- University of Oslo, Norwegian Centre for Addiction Research, Oslo, Norway
| | - Svetlana Skurtveit
- University of Oslo, Norwegian Centre for Addiction Research, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
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Gittins R, Teck JTW, Knowles R, Clarke N, Baldacchino A. Implementing buprenorphine prolonged-release injection using a health at the margins approach for transactional sex-workers. Front Psychiatry 2023; 14:1224376. [PMID: 37547196 PMCID: PMC10400437 DOI: 10.3389/fpsyt.2023.1224376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Background Access to prescribed interventions and retention in treatment services are associated with improved health outcomes and reduced premature mortality rates for people living with opioid use disorder (OUD). In Leeds, transactional sex-workers frequently cycled in and out of treatment for OUD such that they never reached a level of engagement that permitted opportunities to meet their healthcare or housing needs. Barriers to accessing care provision include an itinerant lifestyle, difficulties with travel at unpredictable hours, impacting upon adherence to medication regimens including daily supervised consumption. Objectives To use a co-produced, "health at the margins" approach, to reach the sex-working population in Leeds, and support informed choices about the potential to receive buprenorphine prolonged-release injection (BPRI) as a treatment option for OUD. Methods BPRI was introduced using a theory of change model and improvements in sex-worker care delivery was reviewed. Strategies included buprenorphine micro-induction, shared decision-making, collaborative multi-agency working and supporting a strengths-based and trauma-informed approach. Results Benefits of BPRI included removal of the need for daily pharmacy visits, reducing the risk of diversion, improved medication adherence, stability and engagement with treatment and supportive services. Conclusion BPRI may offer an additional option for pharmacological interventions for people with OUD where there may be increased barriers to accessing treatment for example due to sex-working. Strategies for effective BPRI include micro-induction, shared decision-making, collaborative multi-agency working and supporting a strengths-based approach.
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Affiliation(s)
| | - Joseph Tay Wee Teck
- Forward Leeds and Humankind Charity, Durham, United Kingdom
- Population and Behavioural Science Research Division, School of Medicine, St Andrews University, St Andrews, United Kingdom
| | | | - Nicole Clarke
- Forward Leeds and Humankind Charity, Durham, United Kingdom
| | - Alexander Baldacchino
- Population and Behavioural Science Research Division, School of Medicine, St Andrews University, St Andrews, United Kingdom
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Simon C, Vincent L, Coulter A, Salazar Z, Voyles N, Roberts L, Frank D, Brothers S. The Methadone Manifesto: Treatment Experiences and Policy Recommendations From Methadone Patient Activists. Am J Public Health 2022; 112:S117-S122. [PMID: 35349312 PMCID: PMC8965191 DOI: 10.2105/ajph.2021.306665] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Caty Simon
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - Louise Vincent
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - Abby Coulter
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - Zach Salazar
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - Nick Voyles
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - Lindsay Roberts
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - David Frank
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - Sarah Brothers
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
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Scheidell JD, Ataiants J, Lankenau SE. Miscarriage and Abortion Among Women Attending Harm Reduction Services in Philadelphia: Correlations With Individual, Interpersonal, and Structural Factors. Subst Use Misuse 2022; 57:999-1006. [PMID: 35277115 PMCID: PMC9101319 DOI: 10.1080/10826084.2022.2046100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Reproductive health research among women who use drugs has focused on pregnancy prevention and perinatal/neonatal outcomes, but there have been few investigations of miscarriage and abortion, including prevalence and associated factors. Methods: Using cross-sectional data from a sample of non-pregnant women receiving harm reduction services in Philadelphia in 2016-2017 we examined lifetime miscarriage and abortion (n = 187). Separately for both outcomes, we used modified Poisson regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for associations with each correlate. We also explored correlates of reporting both miscarriage and abortion. Results: Approximately 47% experienced miscarriage, 42% experienced abortion, and 18% experienced both. Miscarriage correlates included: prescription opioid misuse (e.g., OxyContin PR 1.82, 95% CI 1.23, 2.69); 40% increase in prevalence associated with housing instability, 50% increase with survival sex, and two-fold increase with arrest. Abortion correlates included: mental health (e.g., depression PR 2.09, 95% CI 1.18, 3.71), stimulant use (e.g., methamphetamine PR 1.83, 95% CI 1.22, 2.74), and drug injection (PR 1.76, 95% CI 1.03, 3.02); partner controlling access to people/possessions, physical and emotional violence; and a two-fold increase associated with survival sex and arrest. Experiencing both reproductive outcomes was correlated with mental health, opioid and simulant use, housing instability, survival sex, and arrest. Conclusion: Miscarriage and abortion was common among women with history of drug misuse suggesting a need for expanded access to family planning, medication-assisted therapy, and social support services, and for the integration of these with substance use services. Future research in longitudinal data is needed.
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Affiliation(s)
- Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
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Income generation and the patterning of substance use: A gender-based analysis. Drug Alcohol Depend 2021; 226:108862. [PMID: 34198138 PMCID: PMC8356895 DOI: 10.1016/j.drugalcdep.2021.108862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous research has demonstrated how income-generating activities among marginalized people who use drugs (PWUD)-including employment, income assistance, street-based activities, sex work, and illegal activities-can provide both benefit (e.g., additional income) and harm (e.g., violence, criminalization). However, little is known about gender differences in factors such as drug use patterns that are associated with income-generating activities among PWUD. METHODS Using data from prospective cohorts of HIV-positive and HIV-negative PWUD in Vancouver, Canada, we conducted exploratory gender-stratified analyses of associations between substance use patterns and income-generating activities, using generalized linear mixed-models. RESULTS Participants reported income sources as employment (23.4 %), income assistance (88.1 %), street-based activities (24.9 %), sex work (15.2 %), drug dealing (31.5 %), or other illegal activities (13.9 %). GLMM results showed gendered patterns of engagement in specific income-generating activities and some diverging patterns of substance use. For instance, men receiving income assistance were less likely to use opioids (Adjusted odds ratio(AOR) = 0.64; 95 % confidence interval(CI) = 0.50-0.82) and women engaged in sex work were more likely to use crack-cocaine (AOR = 2.74, 95 % CI = 2.22-3.37). However, results reflected primarily converging patterns of substance use between women and men across income-generating activities, particularly for drug dealing and other illegal activities. CONCLUSIONS Our results suggest that substance use patterns may be more closely associated with income generation context than gender. Given potential harms associated with some income generation activities, results highlight the need for further investigation of the social and structural context of income generation, its intersections with gender and substance use, and the expansion of low-threshold work opportunities.
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Winhusen T, Walley A, Fanucchi LC, Hunt T, Lyons M, Lofwall M, Brown JL, Freeman PR, Nunes E, Beers D, Saitz R, Stambaugh L, Oga EA, Herron N, Baker T, Cook CD, Roberts MF, Alford DP, Starrels JL, Chandler RK. The Opioid-overdose Reduction Continuum of Care Approach (ORCCA): Evidence-based practices in the HEALing Communities Study. Drug Alcohol Depend 2020; 217:108325. [PMID: 33091842 PMCID: PMC7533113 DOI: 10.1016/j.drugalcdep.2020.108325] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The number of opioid-involved overdose deaths in the United States remains a national crisis. The HEALing Communities Study (HCS) will test whether Communities That HEAL (CTH), a community-engaged intervention, can decrease opioid-involved deaths in intervention communities (n = 33), relative to wait-list communities (n = 34), from four states. The CTH intervention seeks to facilitate widespread implementation of three evidence-based practices (EBPs) with the potential to reduce opioid-involved overdose fatalities: overdose education and naloxone distribution (OEND), effective delivery of medication for opioid use disorder (MOUD), and safer opioid analgesic prescribing. A key challenge was delineating an EBP implementation approach useful for all HCS communities. METHODS A workgroup composed of EBP experts from HCS research sites used literature reviews and expert consensus to: 1) compile strategies and associated resources for implementing EBPs primarily targeting individuals 18 and older; and 2) determine allowable community flexibility in EBP implementation. The workgroup developed the Opioid-overdose Reduction Continuum of Care Approach (ORCCA) to organize EBP strategies and resources to facilitate EBP implementation. CONCLUSIONS The ORCCA includes required and recommended EBP strategies, priority populations, and community settings. Each EBP has a "menu" of strategies from which communities can select and implement with a minimum of five strategies required: one for OEND, three for MOUD, and one for prescription opioid safety. Identification and engagement of high-risk populations in OEND and MOUD is an ORCCArequirement. To ensure CTH has community-wide impact, implementation of at least one EBP strategy is required in healthcare, behavioral health, and criminal justice settings, with communities identifying particular organizations to engage in HCS-facilitated EBP implementation.
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Affiliation(s)
- Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Alexander Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Laura C Fanucchi
- Division of Infectious Diseases, Department of Medicine, University of Kentucky College of Medicine, Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Tim Hunt
- Columbia University, School of Social Work, Center for Healing of Opioid and Other Substance Use Disorders (CHOSEN), 1255 Amsterdam, Avenue, Rm 806, New York, NY 10027, USA
| | - Mike Lyons
- Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA; Department of Emergency Medicine, University of Cincinnati College of Medicine 231 Albert Sabin Way, Cincinnati, OH 45267, USA
| | - Michelle Lofwall
- Departments of Behavioral Science and Psychiatry, University of Kentucky College of Medicine, Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Jennifer L Brown
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, 789 S Limestone St, Lexington, KY 40536, USA
| | - Edward Nunes
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, Division on Substance Use, 1051 Riverside Drive, New York, NY 10032, USA
| | - Donna Beers
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Richard Saitz
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue 4th Floor, Boston, MA, 02118, USA
| | - Leyla Stambaugh
- Center for Applied Public Health Research, Research Triangle Institute (RTI) International, 6110 Executive Boulevard, Suite 902, Rockville. MD 20852, USA
| | - Emmanuel A Oga
- Center for Applied Public Health Research, Research Triangle Institute (RTI) International, 6110 Executive Boulevard, Suite 902, Rockville. MD 20852, USA
| | - Nicole Herron
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Trevor Baker
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Christopher D Cook
- Opioid/Substance Use Priority Research Area, University of Kentucky, 845 Angliana Ave Lexington, KY 40508, USA
| | - Monica F Roberts
- Opioid/Substance Use Priority Research Area, University of Kentucky, 845 Angliana Ave Lexington, KY 40508, USA
| | - Daniel P Alford
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Joanna L Starrels
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467, USA
| | - Redonna K Chandler
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Rockville, MD 20892, USA
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Clingan SE, Fisher DG, Reynolds GL, Janson MA, Rannalli DA, Huckabay L, Nguyen HHD. Survival Sex Trading in Los Angeles County, California, USA. JOURNAL OF SEX RESEARCH 2020; 57:943-952. [PMID: 31902245 PMCID: PMC7334079 DOI: 10.1080/00224499.2019.1703885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most studies on survival sex, defined as sex trading for money, drugs, or other needs, have limited their focus to adolescents. The current study reports about the relationships between survival sex trading (SST) and high-risk behaviors in a sample of adults. Bivariate analysis shows that HIV-positive status, use of cocaine, ketamine, methamphetamine, heroin, having received drug treatment, and having received medical services are associated with SST. SST are more likely to not use condoms with partners other than their main partner, to have partners who inject drugs and are more likely to use drugs with sex. A logistic regression model included unwanted sexual touching, partner abuse, identifying as bisexual, African American, higher age, gender (women more likely), homelessness, a higher number of sexual partners, having anal sex, injection drug use, HIV seropositivity, crack use, and the likelihood of injecting drugs. The model was retested on independently collected Risk Behavior Assessment (RBA) data and showed significant relationships between survival sex and crack use, gender (women more likely), HIV positivity, identifying as bisexual, having anal sex, African American, and a higher number of sex partners. These findings make it imperative to integrate victimization counseling and HIV education into substance abuse treatment programs.
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Affiliation(s)
- Sarah E Clingan
- Joint Doctoral Program, Interdisciplinary Research on Substance Use, San Diego State University/University of California San Diego
| | - Dennis G Fisher
- Center for Behavioral Research and Services, and Psychology Department, California State University
| | - Grace L Reynolds
- Center for Behavioral Research and Services, and Department of Health Care Administration, California State University
| | - Michael A Janson
- Division of HIV and STD Programs, Los Angeles County Department of Public Health
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Goldenberg S, Watt S, Braschel M, Hayashi K, Moreheart S, Shannon K. Police-related barriers to harm reduction linked to non-fatal overdose amongst sex workers who use drugs: Results of a community-based cohort in Metro Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102618. [PMID: 31838244 DOI: 10.1016/j.drugpo.2019.102618] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND High rates of overdose and overdose-related mortality in North America represent a pressing health and social concern. Women sex workers face severe health and social inequities, which have been linked to structural factors including negative police interactions; however, little is known regarding the burden of overdose or how policing impacts overdose risk amongst sex workers who use drugs. Given this, we aimed to explore the independent effects of experiencing police-related barriers to harm reduction on non-fatal overdose amongst women sex workers who use drugs in Metro Vancouver, Canada over a 7.5-year period. METHODS Data were drawn from An Evaluation of Sex Workers Health Access (AESHA), a community-based open prospective cohort of women sex workers in Metro Vancouver, from 2010 to 2017. Using multivariate logistic regression with generalized estimating equations (GEE), we used a confounder modeling approach to identify the independent effect of experiencing police-related barriers to harm reduction strategies on non-fatal overdose amongst sex workers using drugs within the last six months at each study visit. RESULTS Amongst 624 participants, 7.7% overdosed within the last six months at baseline and 27.6% overdosed during the study period, contributing 287 non-fatal overdose events over the 7.5-year period. 68.6% reported police-related barriers to harm reduction strategies during the study. In a multivariate confounder model, exposure to police-related barriers to harm reduction strategies [AOR: 2.15, CI: 1.60-2.90] was independently associated with higher odds of non-fatal overdose after adjustment for key confounders. CONCLUSIONS Our findings suggest that in the context of the current overdose crisis, adversarial policing practices may undermine access to lifesaving overdose prevention services and exacerbate overdose risks for marginalized women. Findings underscore the urgent need to scale-up access and remove barriers to progressive harm reduction strategies for women sex workers.
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Affiliation(s)
- Shira Goldenberg
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Sarah Watt
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, 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 and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC V6T 1Z3, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Truong C, Krawczyk N, Dejman M, Marshall-Shah S, Tormohlen K, Agus D, Bass J. Challenges on the road to recovery: Exploring attitudes and experiences of clients in a community-based buprenorphine program in Baltimore City. Addict Behav 2019; 93:14-19. [PMID: 30682677 PMCID: PMC6528177 DOI: 10.1016/j.addbeh.2019.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/23/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This qualitative study identifies and describes experiences and challenges to retention of individuals with opioid use disorder (OUD) who participated in a low-threshold combined buprenorphine-peer support treatment program in Baltimore. METHODS In-depth semi-structured interviews with staff and former clients of the Project Connections Buprenorphine Program (PCBP) (9 people) and focus group discussions with current and previous clients of PCBP (7 people) were conducted. Content analysis was used to extract themes regarding barriers to enrolling and remaining in, and transitioning from the program. RESULTS Primary challenges identified by the participants included struggles with cravings and symptoms of withdrawal, comorbid mental health issues, criminal justice system involvement, medication stigma, and conflicts over level of flexibility regarding program requirements and the role of employment. CONCLUSIONS This study identified several obstacles clients face when seeking care through a combined buprenorphine-peer support model. Findings highlight potential programmatic factors that can be improved and additional resources that may support treatment retention rates and better outcomes. Despite challenges, low-threshold and community-based programs can increase access to effective maintenance treatment for OUD, especially among vulnerable populations who may not have access to formal health services.
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Affiliation(s)
- C Truong
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States.
| | - N Krawczyk
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States; Behavioral Health Leadership Institute, 2200 Arden Road, Baltimore, MD 21209, United States.
| | - M Dejman
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States.
| | - S Marshall-Shah
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States.
| | - K Tormohlen
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States.
| | - D Agus
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States; Behavioral Health Leadership Institute, 2200 Arden Road, Baltimore, MD 21209, United States.
| | - J Bass
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States.
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Palis H, Marchand K, Guh D, Brissette S, Lock K, MacDonald S, Harrison S, Anis AH, Krausz M, Marsh DC, Schechter MT, Oviedo-Joekes E. Men's and women's response to treatment and perceptions of outcomes in a randomized controlled trial of injectable opioid assisted treatment for severe opioid use disorder. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:25. [PMID: 28526048 PMCID: PMC5437624 DOI: 10.1186/s13011-017-0110-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/12/2017] [Indexed: 12/04/2022]
Abstract
Background To test whether there are gender differences in treatment outcomes among patients receiving injectable opioids for the treatment of long-term opioid-dependence. The study additionally explores whether men and women have different perceptions of treatment effectiveness. Methods This study is a secondary analysis from SALOME, a double-blind, phase III, randomized controlled trial testing the non-inferiorirty of injectable hydromorphone to injectable diacetylmorphine among 202 long-term street opioid injectors in Vancouver (Canada). Given this was a secondary analysis, no a priori power calaculation was conducted. Differences in baseline characteristics and six-month treatment outcomes (illicit heroin use, opioid use, crack cocaine use, non-legal activities, physical and psychological health scores, urine positive for street heroin markers, and retention) were analysed by gender using fitted models. Responses to an open ended question on reasons for treatment effectiveness were explored with a thematic analysis. Results Men and women differed significantly on a number of characteristics at baseline. For example, women were significantly younger, presented to treatment with significantly higher rates of prior month sex work (31.5% vs. 0%), and used significantly more crack cocaine (14.71 vs. 8.38 days). After six-months of treatment there were no significant differences in treatment outcomes by gender, after adjusting for baseline values. For both men and women, improved health and quality of life were the most common reasons provided for treatment effectiveness, however women were more specific in the types of health improvements. Conclusions Despite presenting to treatment with vulnerabilities not faced to the same extent by men, at six-months women did not differ significantly from men in tested trial efficacy outcomes. While the primary outcome in the trial was the reduction of illicit opioid use, in the open-ended responses both men and women focused their comments on improvement in health and quality of life as reasons for treatment effectiveness. The supervised model of care with injectable medications provides a particularly suitable framework for providing care to opioid-dependent men and women not attracted or retained by other treatments. The absence of statistical differences reported in this secondary analysis may be due to lack of adequate statistical power to detect meaningful effects. Trial registration This trial is registered with ClinicalTrials.gov (NCT01447212) Registered: October 4, 2011 at the following link: https://clinicaltrials.gov/ct2/show/NCT01447212.
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Affiliation(s)
- Heather Palis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Daphne Guh
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Suzanne Brissette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Hôpital Saint-Luc, Montréal, QC, H2X 3J4, Canada
| | - Kurt Lock
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Scott MacDonald
- Providence Crosstown Clinic, Providence Health Care, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Scott Harrison
- Providence Crosstown Clinic, Providence Health Care, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Aslam H Anis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Michael Krausz
- Department of Psychiatry, Faculty of Medicine, Detwiller Pavilion 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
| | - Martin T Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. .,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
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Majer JM, Harris JC, Jason LA. An Examination of Women Ex-Offenders With Methadone Histories. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2017; 61:711-723. [PMID: 26275413 PMCID: PMC5553198 DOI: 10.1177/0306624x15600834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Criminal (drug and prostitution) charges, employment levels (weekly hours), recent substance use in the past 6 months, and primary sources of income were examined among a sample ( n = 106) of women ex-offenders who had opioid use disorders with and without methadone histories. A general linear model was tested to examine differences in relation to methadone use history. Results from a one-way MANCOVA found that those with methadone histories reported significantly higher levels of drug and prostitution charges than those without any methadone history, but no significant differences in terms of weekly hours of employment or recent substance use were observed between groups. Women ex-offenders with methadone histories reported various sources of income beyond employment, and proportionally, more of these women reported prostitution as a primary source of income. Findings suggest that methadone maintenance treatments are not sufficient in meeting the needs of women ex-offenders.
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Jeal N, Macleod J, Salisbury C, Turner K. Identifying possible reasons why female street sex workers have poor drug treatment outcomes: a qualitative study. BMJ Open 2017; 7:e013018. [PMID: 28336736 PMCID: PMC5372151 DOI: 10.1136/bmjopen-2016-013018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIMS To explore street sex workers (SSWs) views and experiences of drug treatment, in order to understand why this population tend to experience poor drug treatment outcomes. DESIGN In-depth interviews. SETTING Bristol, UK. PARTICIPANTS 24 current and exited SSWs with current or previous experience of problematic use of heroin and/or crack cocaine. FINDINGS Participants described how feeling unable to discuss their sex work in drug treatment groups undermined their engagement in the treatment process. They outlined how disclosure of sex work resulted in stigma from male and female service users as well as adverse interactions with male service users. Participants highlighted that non-disclosure meant they could not discuss unresolved trauma issues which were common and which emerged or increased when they reduced their drug use. As trauma experiences had usually involved men as perpetrators participants said it was not appropriate to discuss them in mixed treatment groups. SSWs in recovery described how persistent trauma-related symptoms still affected their lives many years after stopping sex work and drug use. Participants suggested SSW-only services and female staff as essential to effective care and highlighted that recent service changes were resulting in loss of trusted staff and SSW-only treatment services. This was reported to be reducing the likelihood of SSWs engaging in drug services, with the resultant loss of continuity of care and reduced time with staff acting as barriers to an effective therapeutic relationship. CONCLUSIONS SSWs face many barriers to effective drug treatment. SSW-only treatment groups, continuity of care with treatment staff and contact with female staff, particularly individuals who have had similar lived experience, could improve the extent to which SSWs engage and benefit from drug treatment services. Service engagement and outcomes may also be improved by drug services that include identification and treatment of trauma-related symptoms.
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Affiliation(s)
- Nikki Jeal
- Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
| | - John Macleod
- Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
| | - Chris Salisbury
- Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Katrina Turner
- Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Gilchrist G, Singleton N, Donmall M, Jones A. Prevalence and factors associated with sex trading in the year prior to entering treatment for drug misuse in England. Drug Alcohol Depend 2015; 152:116-22. [PMID: 25998258 DOI: 10.1016/j.drugalcdep.2015.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/12/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study estimates the past year prevalence of and factors associated with sex trading (offering sex for money, drugs or something else) among 1796 men and women presenting to 342 drug misuse treatment agencies in England, and identifies service development and delivery implications. METHODS Secondary analysis of baseline data from a prospective cohort was conducted. Short Form-12 measured mental and physical wellbeing, psychiatric diagnoses were self-reported and the circumstances, motivation and readiness tool assessed readiness for/pressure to enter treatment. Logistic regression models determined associations with sex trading separately by sex. Inverse probability population weights were calculated, utilising demographics from the National Drug Treatment Monitoring System and agency specific data collection windows. RESULTS The estimated prevalence rate of sex trading in the past 12 months was 5.1% (15.0% for women and 2.1% for men). For women, adjusted models identified crack use (aOR 1.83, 95% CI 1.22-2.74, p=0.004), previous treatment (aOR 3.00, 95% CI 1.31-6.86, p=0.010) and greater readiness for treatment (aOR 1.12, 95% CI 1.01-1.24, p=0.027) as independently associated with sex trading. For men, lower mental wellbeing (aOR 0.97, 95% CI 0.94-0.99, p=0.030) was independently associated and marginal effects were identified for syringe sharing (aOR 2.89, 95% CI 0.94-8.86, p=0.064) and unprotected sex (aOR 2.23, 95% CI 0.95-5.26, p=0.065). CONCLUSIONS Sex trading among drug misusers is associated with additional health risks and specific treatment needs. Given the scale of the problem it is important that treatment providers have the competencies to adequately address the issue and provide accessible and appropriate services.
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Affiliation(s)
- Gail Gilchrist
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, London SE5 8BB, United Kingdom.
| | - Nicola Singleton
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, London SE5 8BB, United Kingdom.
| | - Michael Donmall
- National Drug Evidence Centre, Institute of Population Health, University of Manchester, Ellen Wilkinson Building, 4th Floor, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Andrew Jones
- National Drug Evidence Centre, Institute of Population Health, University of Manchester, Ellen Wilkinson Building, 4th Floor, Oxford Road, Manchester M13 9PL, United Kingdom.
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Reducing stigma in healthcare and law enforcement: a novel approach to service provision for street level sex workers. Int J Equity Health 2015; 14:35. [PMID: 25879639 PMCID: PMC4404612 DOI: 10.1186/s12939-015-0156-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/24/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Providing services for street level sex workers requires a multidisciplinary approach, addressing both health and safety concerns typical of their age and gender and those that arise specific to their line of work. Despite being a diverse population, studies have identified some specific health needs for sex workers including addictions treatment, mental health. Additionally, studies have shown a higher risk of physical and sexual assault for this population. The Persons at Risk program (PAR) in London, Ontario, Canada was started in 2005 to address the specific needs of street level sex workers by using a harm-reduction model for policing and healthcare provision. This qualitative study evaluated this model of care in terms of improving access to healthcare and essential police services for street level sex workers. Methods A total of 14 semi-structured interviews were conducted with current and former female street level sex workers enrolled in the PAR program. In addition, 3 semi-structured interviews were conducted with health and law enforcement professionals. The research team then analyzed and coded the transcripts using qualitative description to identify key themes in the data. Results Results indicated that participants represent a vulnerable population with increased safety concerns and healthcare needs relating to addictions, mental health and infectious disease. Despite this, participants reported avoiding healthcare workers and police officers in the past because of fear of stigma or repercussions. All participants identified the harm reduction approach of the PAR program as being essential to their continued engagement with the program. Other important aspects included flexible hours, the location of the clinic, streamlined access to mental health and addictions treatment and the female gender of the police and healthcare worker. Conclusions The PAR program provides sex workers access to much needed primary healthcare that is flexible and without judgment. In addition, they are provided with a direct avenue to access law enforcement. We feel a similar model of care could be applicable to many cities across Canada.
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Management of drug misusers in Glasgow general hospitals. DRUGS AND ALCOHOL TODAY 2013. [DOI: 10.1108/dat-09-2012-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to ascertain an awareness of the management of the drug misusing guidelines in Glasgow general hospitals.
Design/methodology/approach
– A brief literature review was carried out to establish the available evidence for the guidelines. Additionally, a survey questionnaire was sent out to junior medical staff requesting their views on the drug misusing guidelines.
Findings
– A paucity of evidence relating to drug misusing guidelines was found from the literature. The Glasgow Guidelines appear to be a welcome source of information that is both comprehensive and easily accessible for staff. Junior medical staffs have broadly welcomed the guidance but would appreciate additional support on the management of patients prescribed Suboxone.
Research limitations/implications
– There should be an increase in training and development for junior medical staff regarding the guideline.
Originality/value
– The Glasgow Guidelines are aimed primarily at junior medical staff whose knowledge on drug misusing patients may be scarce. Increased training and awareness should improve the management of drug misusers in general hospitals. Consequently, patients should spent less time in hospital.
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