Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada

Abstract

Background The nonmedical use of prescription opioids (POs) is a major public health concern, causing extensive morbidity and mortality in North America. Canada has the second highest consumption rate of POs globally and data indicate nonmedical PO use (NPOU) is growing among key populations and increasingly available in street-level drug markets. Despite accumulating evidence documenting the rise of NPOU, few studies have systematically examined NPOU in Canada among key vulnerable populations, such as sex workers. This study prospectively evaluated the prevalence and correlates of NPOU within a Vancouver cohort of sex workers over three-years follow-up. Methods Data were drawn from an open prospective cohort, AESHA (An Evaluation of Sex Workers Health Access) in Metro Vancouver, Canada (2010-2013). Women were recruited through outreach from outdoor street locations and indoor venues. Bivariate and multivariable logistic regression using Generalized Estimating Equations (GEE) were used to examine social and structural correlates of NPOU over 36 months. Results Of the 692 sex workers at baseline, close to one-fifth (n=130, 18.8%) reported NPOU (injection or non-injection) in the last six months. In multivariable GEE analyses, factors independently correlated with recent NPOU were: exchanging sex while high (AOR 3.26, 95%CI 2.29-4.64), police harassment/arrest (AOR 1.83, 95%CI 1.43-2.35), intimate partner injects drugs (AOR 1.66, 95%CI 1.11-2.49), and recent physical/sexual intimate partner violence (AOR 1.65, 95%CI 1.21-2.24). Conclusion Our results demonstrate that nearly one-fifth of sex workers in Metro Vancouver report NPOU. Factors independently statistically associated with NPOU included exchanging sex while high, police harassment/arrest, a drug injecting intimate partner and recent physical/sexual intimate partner violence. The high prevalence of NPOU use among sex workers underscores the need for further prevention and management strategies tailored to this key population. The correlates of NPOU uncovered here suggest that structural interventions may be further implemented to ameliorate this growing concern.

Social and Structural Factors Shaping High Rates of Incarceration among Sex Workers in a Canadian Setting

“…44 The intersection of multiple stigmatized identities has been proposed as a possible explanation of the high rates of substance use among LGBT*2S sex workers. [45][46][47][48][49] This drug dependency, in turn, could further exacerbate LGBT sex workers' risk of incarceration, potentially through police targeting, 27,50 as it was observed in our study. Trans*-sex workers seem to be a particularly vulnerable group within this already marginalized population.…”

“…Variables found to be correlated with incarceration at pG0.10 level in bivariate analyses were considered for inclusion into the multivariable model. As in previous research, 27,28 the multivariable model was constructed using a backward stepwise selection approach. Quasi-likelihood under the independence model criterion (QIC) was used to identify the model with the best overall fit as indicated by the lowest QIC value.…”

Comparing Quality of Life Among Female Sex Workers With and Without Addiction

“…Moreover, several other recent studies have shown the comorbidity of prostitution with Substance Use Disorder (SUD) among FSWs (Matusiewicz et al 2016;Argento et al 2015). However, the serious risk of drug use is higher in female than men (Khajedaluee et al 2013).…”

Burden and correlates of mental health diagnoses among sex workers in an urban setting

“…Although limited research has considered structural determinants of mental health among sex workers, prior studies have reported associations between multi-level factors and HIV/STI risks among sex workers [ 15 , 21 – 26 ] as well as important relationships between social factors, structural factors and mental health in both general and sex worker populations worldwide [ 2 , 4 , 11 , 27 – 29 ]. For our study, we included individual factors previously demonstrated to be associated with health inequities among sex workers including socio-demographic characteristics such as Indigenous ancestry, sexual/gender minority, and substance use patterns [ 17 , 22 , 30 , 31 ]. In addition, we examined common interpersonal/dyad-level factors among sex workers and their clients/partners, including violence, sexual coercion, and influences of drug use [ 21 , 23 , 26 ].…”