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

Overview

Journal Drug Alcohol Depend

Publisher Elsevier

Specialty Psychiatry

Date 2023 Feb 8

PMID 36753803

Authors

Elena Argento

Kate Shannon

Nadia Fairbairn

Sarah Moreheart

Melissa Braschel

Shira Goldenberg

Affiliations

Soon will be listed here.

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.

Citing Articles

A scoping review on barriers and facilitators to harm reduction care among youth in British Columbia, Canada.

Beck K, Pallot K, Amri M Harm Reduct J. 2024; 21(1):189.

PMID: 39444020 PMC: 11520168. DOI: 10.1186/s12954-024-01063-1.

Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis.

Byrne C, Sani F, Thain D, Fletcher E, Malaguti A Harm Reduct J. 2024; 21(1):81.

PMID: 38622647 PMC: 11017611. DOI: 10.1186/s12954-024-00999-8.

References

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

Platt L, Grenfell P, Meiksin R, Elmes J, Sherman S, Sanders T . Associations between sex work laws and sex workers' health: A systematic review and meta-analysis of quantitative and qualitative studies. PLoS Med. 2018; 15(12):e1002680. PMC: 6289426. DOI: 10.1371/journal.pmed.1002680. View

Rouhani S, White R, Park J, Sherman S . High willingness to use overdose prevention sites among female sex workers in Baltimore, Maryland. Drug Alcohol Depend. 2020; 212:108042. PMC: 9426862. DOI: 10.1016/j.drugalcdep.2020.108042. View

Degenhardt L, Mathers B, Guarinieri M, Panda S, Phillips B, Strathdee S . Meth/amphetamine use and associated HIV: Implications for global policy and public health. Int J Drug Policy. 2010; 21(5):347-58. DOI: 10.1016/j.drugpo.2009.11.007. View

Argento E, Goldenberg S, Braschel M, Machat S, Strathdee S, Shannon K . The impact of end-demand legislation on sex workers' access to health and sex worker-led services: A community-based prospective cohort study in Canada. PLoS One. 2020; 15(4):e0225783. PMC: 7135091. DOI: 10.1371/journal.pone.0225783. View

Brooks O, Bach P, Dong H, Milloy M, Fairbairn N, Kerr T . Crystal methamphetamine use subgroups and associated addiction care access and overdose risk in a Canadian urban setting. Drug Alcohol Depend. 2022; 232:109274. PMC: 8890780. DOI: 10.1016/j.drugalcdep.2022.109274. View

Cooper H, Moore L, Gruskin S, Krieger N . The impact of a police drug crackdown on drug injectors' ability to practice harm reduction: a qualitative study. Soc Sci Med. 2005; 61(3):673-84. DOI: 10.1016/j.socscimed.2004.12.030. View

Csete J, Cohen J . Health benefits of legal services for criminalized populations: the case of people who use drugs, sex workers and sexual and gender minorities. J Law Med Ethics. 2010; 38(4):816-31. DOI: 10.1111/j.1748-720X.2010.00535.x. View

Victor G, Zettner C, Huynh P, Ray B, Sightes E . Jail and overdose: assessing the community impact of incarceration on overdose. Addiction. 2021; 117(2):433-441. DOI: 10.1111/add.15640. View

10.

McBride B, Goldenberg S, Murphy A, Wu S, Braschel M, Krusi A . Third Parties (Venue Owners, Managers, Security, etc.) and Access to Occupational Health and Safety Among Sex Workers in a Canadian Setting: 2010-2016. Am J Public Health. 2019; 109(5):792-798. PMC: 6459658. DOI: 10.2105/AJPH.2019.304994. View

11.

Collins A, Boyd J, Mayer S, Fowler A, Kennedy M, Bluthenthal R . Policing space in the overdose crisis: A rapid ethnographic study of the impact of law enforcement practices on the effectiveness of overdose prevention sites. Int J Drug Policy. 2019; 73:199-207. PMC: 7147938. DOI: 10.1016/j.drugpo.2019.08.002. View

12.

Boyd J, Collins A, Mayer S, Maher L, Kerr T, McNeil R . Gendered violence and overdose prevention sites: a rapid ethnographic study during an overdose epidemic in Vancouver, Canada. Addiction. 2018; 113(12):2261-2270. PMC: 6400212. DOI: 10.1111/add.14417. View

13.

El-Bassel N, Norcini Pala A, Mukherjee T, McCrimmon T, Mergenova G, Terlikbayeva A . Association of Violence Against Female Sex Workers Who Use Drugs With Nonfatal Drug Overdose in Kazakhstan. JAMA Netw Open. 2020; 3(10):e2020802. PMC: 7550967. DOI: 10.1001/jamanetworkopen.2020.20802. View

14.

Argento E, Chettiar J, Nguyen P, Montaner J, Shannon K . Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada. Int J Drug Policy. 2014; 26(1):59-66. PMC: 4277711. DOI: 10.1016/j.drugpo.2014.07.010. View

15.

Ahamad K, DeBeck K, Feng C, Sakakibara T, Kerr T, Wood E . Gender influences on initiation of injecting drug use. Am J Drug Alcohol Abuse. 2014; 40(2):151-6. PMC: 4454335. DOI: 10.3109/00952990.2013.860983. View

16.

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. Int J Drug Policy. 2019; 76:102618. PMC: 7673668. DOI: 10.1016/j.drugpo.2019.102618. View

17.

Tavakoli F, Khezri M, Tam M, Bazrafshan A, Sharifi H, Shokoohi M . Injection and non-injection drug use among female sex workers in Iran: A systematic review and meta-analysis. Drug Alcohol Depend. 2021; 221:108655. DOI: 10.1016/j.drugalcdep.2021.108655. View

18.

Shannon K, Strathdee S, Shoveller J, Zhang R, Montaner J, Tyndall M . Crystal methamphetamine use among female street-based sex workers: Moving beyond individual-focused interventions. Drug Alcohol Depend. 2010; 113(1):76-81. PMC: 3392206. DOI: 10.1016/j.drugalcdep.2010.07.011. View

19.

Stueve A, ODonnell L, Duran R, San Doval A, Blome J . Time-space sampling in minority communities: results with young Latino men who have sex with men. Am J Public Health. 2001; 91(6):922-6. PMC: 1446469. DOI: 10.2105/ajph.91.6.922. View

20.

Argento E, Strathdee S, Goldenberg S, Braschel M, Montaner J, Shannon K . Violence, trauma and living with HIV: Longitudinal predictors of initiating crystal methamphetamine injection among sex workers. Drug Alcohol Depend. 2017; 175:198-204. PMC: 5496650. DOI: 10.1016/j.drugalcdep.2017.02.014. View