Sex work involvement among women with long-term opioid injection drug dependence who enter opioid agonist treatment

Kirsten Marchand, Eugenia Oviedo-Joekes, Daphne Guh, David C Marsh, Suzanne Brissette, Martin T Schechter, Kirsten Marchand, Eugenia Oviedo-Joekes, Daphne Guh, David C Marsh, Suzanne Brissette, Martin T Schechter

Abstract

Background: Substitution with opioid-agonists (e.g., methadone) has shown to be an effective treatment for chronic long-term opioid dependency. Survival sex work, very common among injection drug users, has been associated with poor Opioid Agonist Treatment (OAT) engagement, retention and response. Therefore, this study was undertaken to determine factors associated with engaging in sex work among long-term opioid dependent women receiving OAT.

Methods: Data from a randomized controlled trial, the North American Opiate Medication Initiative (NAOMI), conducted in Vancouver and Montreal (Canada) between 2005-2008, was analyzed. The NAOMI study compared the effectiveness of oral methadone to injectable diacetylmorphine or injectable hydromorphone, the last two on a double blind basis, over 12 months. A research team, independent of the clinic services, obtained outcome evaluations at baseline and follow-up (3, 6, 9, 12, 18 and 24 months).

Results: A total 53.6% of women reported engaging in sex work in at least one of the research visits. At treatment initiation, women who were younger and had fewer years of education were more likely to be engaged in sex work. The multivariate logistic generalized estimating equation regression analysis determined that psychological symptoms, and high illicit heroin and cocaine use correlated with women's involvement in sex work during the study period.

Conclusions: After entering OAT, women using injection drugs and engaging in sex work represent a particularly vulnerable group showing poorer psychological health and a higher use of heroin and cocaine compared to women not engaging in sex work. These factors must be taken into consideration in the planning and provision of OAT in order to improve treatment outcomes.

Trial registration: NCT00175357.

References

    1. Kuyper LM, Hogg RS, Montaner JSG, Schechter MT, Wood E. The Cost of Inaction on Hiv Transmission Among Injection Drug Users and the Potential for Effective Interventions. Journal of Urban Health-Bulletin of the New York Academy of Medicine. 2004;81:655–660. doi: 10.1093/jurban/jth148.
    1. Gowing L, Farrell M, Bornemann R, Sullivan L, Ali R. Substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev. 2008. p. CD004145.
    1. March JC, Oviedo-Joekes E, Romero M. Drugs and social exclusion in ten European cities. Eur Addict Res. 2006;12:33–41. doi: 10.1159/000088581.
    1. Spittal PM, Bruneau J, Craib KJ, Miller C, Lamothe F, Weber AE, Li K, Tyndall MW, O'Shaughnessy MV, Schechter MT. Surviving the sex trade: a comparison of HIV risk behaviours among street-involved women in two Canadian cities who inject drugs. AIDS Care. 2003;15:187–95. doi: 10.1080/0954012031000068335.
    1. Mehrabadi A, Craib KJ, Patterson K, Adam W, Moniruzzaman A, Ward-Burkitt B, Schechter MT, Spittal PM. The Cedar Project: a comparison of HIV-related vulnerabilities amongst young Aboriginal women surviving drug use and sex work in two Canadian cities. Int J Drug Policy. 2008;19:159–68. doi: 10.1016/j.drugpo.2007.07.005.
    1. Chettiar J, Shannon K, Wood E, Zhang R, Kerr T. Survival sex work involvement among street-involved youth who use drugs in a Canadian setting. J Public Health (Oxf) 2010;32:322–7. doi: 10.1093/pubmed/fdp126.
    1. Shannon K, Bright V, Gibson K, Tyndall MW. Sexual and drug-related vulnerabilities for HIV infection among women engaged in survival sex work in Vancouver, Canada. Can J Public Health. 2007;98:465–9.
    1. Eiroa-Orosa FJ, Verthein U, Kuhn S, Lindemann C, Karow A, Haasen C, Reimer J. Implication of gender differences in heroin-assisted treatment: results from the German randomized controlled trial. Am J Addict. 2010;19:312–8.
    1. Oviedo-Joekes E, Guh D, Brissette S, Marchand K, Marsh D, Chettiar J, Nosyk B, Krausz M, Anis A, Schechter MT. Effectiveness of diacetylmorphine versus methadone for the treatment of opioid dependence in women. Drug Alcohol Depend. 2010.
    1. Paone D, Cooper H, Alperen J, Shi Q, Des Jarlais DC. HIV risk behaviours of current sex workers attending syringe exchange: the experiences of women in five US cities. AIDS Care. 1999;11:269–80. doi: 10.1080/09540129947910.
    1. Kuyper LM, Palepu A, Kerr T, Li K, Miller CL, Spittal PM, Hogg RS, Montaner JSG, Wood E. Factors Associated With Sex-Trade Involvement Among Female Injection Drug Users in a Canadian Setting. Addiction Research & Theory. 2005;13:193–199. doi: 10.1080/16066350500053349.
    1. El-Bassel N, Simoni JM, Cooper DK, Gilbert L, Schilling RF. Sex trading and psychological distress among women on methadone. Psychol Addict Behav. 2001;15:177–84.
    1. Miller CL, Kerr T, Frankish JC, Spittal PM, Li K, Schechter MT, Wood E. Binge Drug Use Independently Predicts HIV Seroconversion Among Injection Drug Users: Implications for Public Health Strategies. Subst Use Misuse. 2006;41:199–210. doi: 10.1080/10826080500391795.
    1. Astemborski J, Vlahov D, Warren D, Solomon L, Nelson KE. The trading of sex for drugs or money and HIV seropositivity among female intravenous drug users. Am J Public Health. 1994;84:382–7. doi: 10.2105/AJPH.84.3.382.
    1. Kral AH, Bluthenthal RN, Lorvick J, Gee L, Bacchetti P, Edlin BR. Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet. 2001;357:1397–401. doi: 10.1016/S0140-6736(00)04562-1.
    1. Miller CL, Spittal PM, LaLiberte N, Li K, Tyndall MW, O'Shaughnessy MV, Schechter MT. Females experiencing sexual and drug vulnerabilities are at elevated risk for HIV infection among youth who use injection drugs. J Acquir Immune Defic Syndr. 2002;30:335–41.
    1. Gu J, Lau JT, Chen H, Tsui H, Ling W. Prevalence and factors related to syringe sharing behaviours among female injecting drug users who are also sex workers in China. Int J Drug Policy. 2010.
    1. Haasen C, van den Brink W. Innovations in agonist maintenance treatment of opioid-dependent patients. Curr Opin Psychiatry. 2006;19:631–636. doi: 10.1097/01.yco.0000245759.13997.9d.
    1. Ward J, Hall W, Mattick RP. Role of maintenance treatment in opioid dependence. Lancet. 1999;353:221–6. doi: 10.1016/S0140-6736(98)05356-2.
    1. Amato L, Davoli M, A Perucci C, Ferri M, Faggiano F, P Mattick R. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. J Subst Abuse Treat. 2005;28:321–9. doi: 10.1016/j.jsat.2005.02.007.
    1. Callon C, Wood E, Marsh D, Li K, Montaner J, Kerr T. Barriers and facilitators to methadone maintenance therapy use among illicit opiate injection drug users in Vancouver. J Opioid Manag. 2006;2:35–41.
    1. Kerr T, Marsh D, Li K, Montaner J, Wood E. Factors associated with methadone maintenance therapy use among a cohort of polysubstance using injection drug users in Vancouver. Drug Alcohol Depend. 2005;80:329–35. doi: 10.1016/j.drugalcdep.2005.05.002.
    1. Perreault M, Rousseau M, Lauzon P, Mercier C, Tremblay I, Héroux M. Determinants of Retention in a Canadian Low-Threshold Methadone Maintenance Program. Journal of Maintenance in the Addictions. 2007;3:37–51.
    1. Oviedo-Joekes E, Brissette S, Marsh DC, Lauzon P, Guh D, Anis A, Schechter MT. Diacetylmorphine versus methadone for the treatment of opioid addiction. N Engl J Med. 2009;361:777–86. doi: 10.1056/NEJMoa0810635.
    1. Oviedo-Joekes E, Nosyk B, Marsh D, Guh D, Brissette S, Gartry C, Krausz M, Anis A, Schechter MT. Scientific and political challenges in North America's first randomized controlled trial of heroin-assisted treatment for severe heroin addiction: Rationale and design of the NAOMI Study. Clinical Trials. 2009;6:261–271. doi: 10.1177/1740774509105222.
    1. Oviedo-Joekes E, Nosyk B, Brissette S, Chettiar J, Schneeberger P, Marsh DC, Krausz M, Anis A, Schechter MT. The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America's First Trial of Heroin-Assisted Treatment. J Urban Health. 2008;85:812–25. doi: 10.1007/s11524-008-9312-9.
    1. Health Canada Best practices in methadone maintenance treatment. Ontario, Canada.: Minister of Public Works and Government Services Canada; 2002.
    1. Kokkevi A, Hartgers C. EuropASI: European adaptation of a multidimensional assessment instrument for drug and alcohol dependence. European Addiction Research. 1995;1:208–210. doi: 10.1159/000259089.
    1. Marsden J, Gossop M, Stewart D, Best D, Farrell M, Lehmann P, Edwards C, Strang J. The Maudsley Addiction Profile (MAP): a brief instrument for assessing treatment outcome. Addiction. 1998;93:1857–67. doi: 10.1046/j.1360-0443.1998.9312185711.x.
    1. van der Zanden BP, Dijkgraaf MG, Blanken P, de Borgie CA, van Ree JM, van den Brink W. Validity of the EQ-5D as a generic health outcome instrument in a heroin-dependent population. Drug Alcohol Depend. 2006;82:111–8. doi: 10.1016/j.drugalcdep.2005.08.012.
    1. Jarrin I, Lumbreras B, Ferreros I, Perez-Hoyos S, Hurtado I, Hernandez-Aguado I. Effect of education on overall and cause-specific mortality in injecting drug users, according to HIV and introduction of HAART. Int J Epidemiol. 2007;36:187–94.
    1. Galai N, Safaeian M, Vlahov D, Bolotin A, Celentano DD. Longitudinal patterns of drug injection behavior in the ALIVE Study cohort,1988-2000: description and determinants. Am J Epidemiol. 2003;158:695–704. doi: 10.1093/aje/kwg209.
    1. Hser YI, Hoffman V, Grella CE, Anglin MD. A 33-year follow-up of narcotics addicts. Arch Gen Psychiatry. 2001;58:503–8. doi: 10.1001/archpsyc.58.5.503.
    1. Acharyya S, Zhang H. Assessing sex differences on treatment effectiveness from the drug abuse treatment outcome study (DATOS) Am J Drug Alcohol Abuse. 2003;29:415–44. doi: 10.1081/ADA-120020524.
    1. Stewart D, Gossop M, Marsden J, Kidd T, Treacy S. Similarities in outcomes for men and women after drug misuse treatment: results from the National Treatment Outcome Research Study (NTORS) Drug Alcohol Rev. 2003;22:35–41. doi: 10.1080/0959523021000059811.
    1. Gilchrist G, Gruer L, Atkinson J. Comparison of drug use and psychiatric morbidity between prostitute and non-prostitute female drug users in Glasgow, Scotland. Addict Behav. 2005;30:1019–23. doi: 10.1016/j.addbeh.2004.09.003.
    1. El-Bassel N, Witte SS, Wada T, Gilbert L, Wallace J. Correlates of partner violence among female street-based sex workers: substance abuse, history of childhood abuse, HIV risks. AIDS Patient Care STDS. 2001;15:41–51. doi: 10.1089/108729101460092.
    1. Stoltz JA, Shannon K, Kerr T, Zhang R, Montaner JS, Wood E. Associations between childhood maltreatment and sex work in a cohort of drug-using youth. Soc Sci Med. 2007;65:1214–21. doi: 10.1016/j.socscimed.2007.05.005.
    1. Charney DA, Palacios-Boix J, Gill KJ. Sexual abuse and the outcome of addiction treatment. Am J Addict. 2007;16:93–100. doi: 10.1080/10550490601184225.
    1. Kang SY, Deren S, Goldstein MF. Relationships between childhood abuse and neglect experience and HIV risk behaviors among methadone treatment drop-outs. Child Abuse Negl. 2002;26:1275–89. doi: 10.1016/S0145-2134(02)00412-X.
    1. Pirard S, Sharon E, Kang SK, Angarita GA, Gastfriend DR. Prevalence of physical and sexual abuse among substance abuse patients and impact on treatment outcomes. Drug Alcohol Depend. 2005;78:57–64. doi: 10.1016/j.drugalcdep.2004.09.005.
    1. Tiet QQ, Finney JW, Moos RH. Recent sexual abuse, physical abuse, suicide attempts among male veterans seeking psychiatric treatment. Psychiatr Serv. 2006;57:107–13. doi: 10.1176/appi.ps.57.1.107.
    1. Langeland W, Draijer N, van den Brink W. Assessment of lifetime physical and sexual abuse in treated alcoholics. Validity of the Addiction Severity Index. Addict Behav. 2003;28:871–81. doi: 10.1016/S0306-4603(01)00297-0.
    1. Najavits LM, Weiss RD, Reif S, Gastfriend DR, Siqueland L, Barber JP, Butler SF, Thase M, Blaine J. The Addiction Severity Index as a screen for trauma and posttraumatic stress disorder. J Stud Alcohol. 1998;59:56–62.

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