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Overdose Risk and Acquiring Opioids for Nonmedical Use Exclusively from Physicians in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-06-26
Abstract: 

Background: A primary response to the alarming rise in overdose and mortality due to nonmedical prescription opioid (PO) use has been to restrict opioid prescribing; however, little is known about the relationship between obtaining opioids from a physician and overdose risk among people who use POs nonmedically and illicit street drugs.

 

Objectives: Investigate the relationship between non-fatal overdose and acquiring POs exclusively from physicians for the purposes of engaging in nonmedical PO use.

 

Methods: Data were collected between 2013 and 2016 among participants in two harmonized prospective cohort studies of people who use drugs in Vancouver: the At-Risk Youth Study (ARYS) and the Vancouver Injection Drug Users Study (VIDUS). Analyses were restricted to participants who engaged in nonmedical PO use and used generalized estimating equations.

 

Results: Among 599 participants who used POs nonmedically, 82 (14%) individuals reported acquiring POs exclusively from a physician and 197 (33%) experienced a non-fatal overdose at some point over the study period. Acquiring POs exclusively from physicians was significantly and negatively associated with non-fatal overdose in the bivariate analysis (Odds Ratio=0.60, 95% Confidence Interval (CI): 0.39-0.94) but not the final multivariate analysis (Adjusted Odds Ratio =0.87, 95% CI: 0.53-1.44).

 

Conclusions: Compared to individuals who acquired POs from friends or the streets, participants who acquired POs exclusively from a physician were not at an increased risk of non-fatal overdose. Although responsible opioid prescribing is an important priority, additional strategies to address nonmedical PO use are urgently needed to reduce overdose and related morbidity and mortality.

Document type: 
Article

Beyond Sex and Gender Difference in Funding and Reporting of Health Research

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-08-28
Abstract: 

Background  Understanding sex and gender in health research can improve the quality of scholarship and enhance health outcomes. Funding agencies and academic journals are two key gatekeepers of knowledge production and dissemination, including whether and how sex/gender is incorporated into health research. Though attention has been paid to key issues and practices in accounting for sex/gender in health funding agencies and academic journals, to date, there has been no systematic analysis documenting whether and how agencies and journals require attention to sex/gender, what conceptual explanations and practical guidance are given for such inclusion, and whether existing practices reflect the reality that sex/gender cannot be separated from other axes of inequality.

Methods  Our research systematically examines official statements about sex/gender inclusion from 45 national-level funding agencies that fund health research across 36 countries (covering the regions of the EU and associated countries, North America, and Australia) and from ten top-ranking general health (the top five in “science” and the top five in “social science”) and ten sex- and/or gender-related health journals. We explore the extent to which agencies and journals require inclusion of sex/gender considerations and to what extent existing strategies reflect state of the art understandings of sex/gender, including intersectional perspectives.

Results  The research highlights the following: (a) there is no consistency in whether sex/gender are mentioned in funding and publishing guidelines; (b) there is wide variation in how sex/gender are conceptualized and how researchers are asked to address the inclusion/exclusion of sex/gender in research; (c) funding agencies tend to prioritize male/female equality in research teams and funding outcomes over considerations of sex/gender in research content and knowledge production; and (d) with very few exceptions, agency and journal criteria fail to recognize the complexity of sex/gender, including the intersection of sex/gender with other key factors that shape health.

Conclusions  The conceptualization and integration of sex/gender needs to better capture the interacting and complex factors that shape health—an imperative that can be informed by an intersectional approach. This can strengthen current efforts to advance scientific excellence in the production and reporting of research. We provide recommendations and supporting questions to strengthen consideration of sex/gender in policies and practices of health journals and funding agencies.

Document type: 
Article
File(s): 

Hospitalization among Street-involved Youth Who Use Illicit Drugs in Vancouver, Canada: A Longitudinal Analysis

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-03-20
Abstract: 

Background: Street-involved youth who use illicit drugs are at high risk for health-related harms; however, the profile of youth at greatest risk of hospitalization has not been well described. We sought to characterize hospitalization among street-involved youth who use illicit drugs and identify the most frequent medical reasons for hospitalization among this population.

Methods: From January 2005 to May 2016, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth in Vancouver, Canada. Multivariable generalized estimating equation (GEE) was used to identify factors associated with hospitalization.

Results: Among 1216 participants, 373 (30.7%) individuals reported hospitalization in the previous 6 months at some point during the study period. The top three reported medical reasons for hospital admission were the following: mental illness (37.77%), physical trauma (12.77%), and drug-related issues (12.59%). Factors significantly associated with hospitalization were the following: past diagnosis of a mental illness (adjusted odds ratio [AOR] = 1.85; 95% confidence interval [95% CI] 1.47–2.33), frequent cocaine use (AOR = 2.15; 95% CI 1.37–3.37), non-fatal overdose (AOR = 1.76; 95% CI 1.37–2.25), and homelessness (AOR = 1.40; 95% CI 1.16–1.68) (all p < 0.05).

Conclusions: Findings suggest that mental illness is a key driver of hospitalization among our sample. Comprehensive approaches to mental health and substance use in addition to stable housing offer promising opportunities to decrease hospitalization among this vulnerable population.

Document type: 
Article
File(s): 

Intergenerational Trauma: The Relationship between Residential Schools and the Child Welfare System among Young People Who Use Drugs

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-08
Abstract: 

Purpose: This study investigated the relationship between familial residential school system (RSS) exposure and personal child welfare system (CWS) involvement among young people who use drugs (PWUD).

Methods: Data were obtained from two linked cohorts of PWUD in Vancouver, Canada and restricted to Indigenous participants. Multivariable logistic regression analysis was used to investigate the relationship between three categories of familial RSS exposure (none; grandparent; parent) and CWS involvement. A secondary analysis assessed the likelihood of CWS involvement between non-Indigenous and Indigenous PWUD with no familial RSS exposure.

Results: Between December 2011 and May 2016, 675 PWUD (age<35) were included in this study, 40% identified as Indigenous. In multivariable analyses, compared to Indigenous participants with no RSS exposure (reference), those with a grandparent in the RSS had a higher likelihood of having been in CWS (Adjusted Odds Ratio [AOR]=1.34, 95% Confidence Interval [CI]: 0.67-2.71), as did those with a parent exposed to RSS (AOR=2.03, 95% CI: 1.03-3.99). In secondary analysis, the odds of CWS involvement was not significantly different between non-Indigenous and Indigenous PWUD with no familial RSS exposure (AOR=0.63, 95% CI: 0.38–1.06).

Conclusions: We observed a dose-response-type trend between familial RSS exposure and personal CWS involvement, and a non-significant difference in the likelihood of CWS involvement between Indigenous and non-Indigenous PWUD when controlling for RSS exposure. These data demonstrate the intergenerational impact of the RSS on the overrepresentation of Indigenous youth in the CWS. Findings have critical implications for public policy and practice including reconciliation efforts with Indigenous Peoples.

Document type: 
Article

A Gender-Based Analysis of Nonmedical Prescription Opioid Use Among People Who Use Illicit Drugs

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-05-21
Abstract: 

Abstract:  Background: Research investigating the unique impacts associated with engaging in nonmedical prescription opioid use (NMPOU) among males and females who also use illicit drugs is needed.

Methods:  Data were collected between 2013 and 2017 from two linked prospective cohort studies in Vancouver: the At-Risk Youth Study and Vancouver Injection Drug Users Study. Generalized estimating equations were used to identify factors associated with engaging in NMPOU among females and males separately.

Results:  Among 1,459 participants, 534 were female (37%). Similar proportions of females (46%) and males (48%) engaged in NMPOU at their first visit during the study period. In multivariable analyses, factors associated with NMPOU among both males and females included heroin use, overdose, drug dealing, and difficulty accessing health and social services. Among females, those who engaged in NMPOU were more likely to report Caucasian or white ethnicity, cocaine use, crystal methamphetamine use, and sex work; among males, those who engaged in NMPOU were older, reported crack use and engaged in binge drug use (all p<0.05).

Conclusion:  The prevalence of NMPOU was similar among males and females who use illicit drugs in Vancouver, and NMPOU was independently associated with markers of vulnerability among both genders. Findings highlight the need for a comprehensive public health approach to address NMPOU that integrates overdose prevention and reversal services, employment opportunities, and better access to services for both women and men.

Document type: 
Article

Gender, Victimization, and Commercial Sex: A Comparative Study

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2109-11-07
Abstract: 

This article critically examines and compares adult male and female experiences selling sex in Canada’s off-street sex industry. Findings indicate that gender disparities exist when it comes to the work of selling sex: male providers are better insulated from violence and exploitation because of their gender, while female sex workers are forced to navigate multiple layers of oppression to assure safer working conditions. Despite these differences, this data suggests that prioritizing overarching labour issues, instead of gendered experiences working in commercial sex, can function to increase all sex workers’ safety and access to justice.

Document type: 
Article
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Coercion Into Addiction Treatment and Subsequent Substance Use Patterns Among People Who Use Illicit Drugs in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-09-06
Abstract: 

Background and Aims: Many people who use drugs (PWUD) are coerced into receiving treatment. This study aimed to assess changes in substance use and related outcomes before versus after treatment in people coerced into treatment, voluntarily attending treatment or not attending treatment.

 

Design: Data from three linked prospective cohort studies of PWUD were used. McNemar’s test and non-linear growth curve modeling were employed to: a) assess changes in substance use patterns before and after coerced addiction treatment and b) compare these changes with changes in PWUD who 1) voluntarily accessed and 2) did not access treatment.

 

Setting: Vancouver, Canada.

 

Participants: 3,196 community-recruited PWUD.

 

Measurements: The outcome variables were substance use and related outcomes assessed by self-reported questionnaire. The input variable was self-reported coerced addiction treatment (defined as being forced into addiction treatment by a doctor or the criminal justice system), voluntary treatment versus no treatment.

 

Findings: Between September 2005 and June 2015, 399 (12.5%) participants reported being coerced into addiction treatment. In McNemar’s test, there were no statistically significant reductions in within-group substance use outcomes for people coerced into treatment, voluntarily attending treatment or not attending treatment. In non-linear growth curve analyses, there were no statistically significant differences in the before and after substance use patterns between those coerced into treatment versus either of the two control groups (all p>0.05). In sub-analyses, we found no statistically significant differences in substance use patterns between people who reported formal coerced treatment through the criminal justice system and people who reported informal coerced treatment through a physician.

 

Conclusions: Among PWUD in Vancouver, Canada, there appear to be no statistically significant improvements in substance use outcomes among those reporting coerced addiction treatment, those voluntarily accessing treatment, and those not attending treatment.

Document type: 
Article

Street-Involved Youth Engaged In Sex Work at Increased Risk of Syringe Sharing

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-07-12
Abstract: 

Syringe sharing places street-involved young people at risk of acquiring HIV and hepatitis C. While markers of economic marginalization, such as homelessness, have been linked with syringe sharing and have led to targeted interventions, the relationship between syringe sharing and other markers of economic vulnerability, such as sex work, are not well documented among young people. This study examines whether those engaged in sex work are at increased risk of syringe borrowing and syringe lending among street-involved youth who use injection drugs in Vancouver, Canada. Between September 2005 and May 2014, data was collected from the At-Risk Youth Study (ARYS), a prospective cohort of street involved youth aged 14-26. Generalized estimating equations with a confounding model building approach was used to examine the relationship between sex work and syringe borrowing and lending. 498 youth reported injecting drugs at some point during the study period and were therefore included in the analysis. In multivariable analysis, youth who engaged in sex work were at an elevated risk of both syringe borrowing (Adjusted Odds Ratio (AOR) = 2.17, 95% Confidence Interval [CI] = 1.40-3.36) and syringe lending (AOR = 1.66, 95% CI = 1.07-2.59). Our study found that youth engaged in street-based sex work were at a significantly higher risk of both syringe borrowing and lending among youth who use injection drugs in Vancouver. Ready access to clean syringes, safer working conditions for sex workers to enable risk reduction measures, and increased access to addiction treatment are identified as promising opportunities for reducing syringe sharing in this setting.

Document type: 
Article
File(s): 

Characterizing Men Who Have Sex with Men and Use Injection Drugs in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-07-20
Abstract: 

We examined factors associated with reporting sex with men among men who inject drugs in Vancouver, Canada. Data were drawn from three open prospective cohorts of people who use drugs between 2005 and 2014. Generalized estimating equations were used to identify factors associated with reporting non-transactional sex with men (MSM) in the previous six months. Of 1663 men who used injection drugs, 225 (13.5%) were MSM over the study period. Sex with men was independently associated with younger age (Adjusted Odds Ratio [AOR]=0.96), childhood sexual abuse (AOR=2.65), sex work (AOR=3.33), crystal methamphetamine use (AOR=1.30), borrowing used syringes (AOR=1.39), inconsistent condom use (AOR=1.76), and HIV seropositivity (AOR=3.82). MSM were less likely to be Hepatitis C-positive (AOR=0.43) and to have accessed addiction treatment in the previous six months (AOR=0.83) (all p<0.05). Findings highlight vulnerabilities and resiliencies among MSM-PWID and indicate a need for trauma-informed and affirming harm reduction and substance use treatment services for MSM-PWID.

Document type: 
Article

Homelessness and Incarceration Associated With Relapse into Stimulant and Opioid Use among Youth Who Are Street-Involved in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-05-09
Abstract: 

Introduction and Aims: While much research has sought to identify the factors associated with initiation and cessation of various forms of drug use among vulnerable youth, little is known about relapse into drug use in this population. We sought to characterize relapse into stimulant and opioid use among street-involved youth in Vancouver, Canada.

Design and Methods: Data were collected between 2005 and 2017 from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth who use illicit drugs in Vancouver. Multivariable extended Cox regression was utilized to identify factors associated with relapse into harder drug use among youth who had previously ceased using stimulants and/or opioids for six months or longer.

Results: Among 246 participants who reported a period of cessation lasting six months or longer, 165 (67.1%) relapsed at some point during study follow-up. Youth who were recently incarcerated (adjusted hazard ratio [AHR]: 1.47), homeless (AHR: 1.40), or had a history of daily stimulant use (AHR: 1.64) were significantly more likely to report relapse, while youth of who identified as white (AHR: 0.78) were significantly less likely to report relapse (all p <0.05).

Discussion: Relapse into harder drug use was common among youth in our setting, and incarceration, homelessness, and daily stimulant use (pre-cessation) were found to be positively associated with relapse among street-involved youth.

Conclusions: Findings suggest that increased access to youth housing supports and alternatives to the criminalization of drug use may help to reduce the rates of relapse into harder drugs in this population.

Document type: 
Article