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

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

doi:10.1186/1477-7517-9-8

Abstract

BackgroundSubstitution 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.MethodsData 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).ResultsA 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.ConclusionsAfter 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 RegistrationNCT00175357.

Highlights

Substitution with opioid-agonists has shown to be an effective treatment for chronic long-term opioid dependency
The present study aims to determine if health, illicit drug use and treatment retention were associated with engaging in sex work after initiating Opioid Agonist Treatment (OAT) in a cohort of long-term opioid injection drug users
The multivariate analysis of factors associated with baseline sex work indicated that younger women

Summary

Introduction

Substitution with opioid-agonists (e.g., methadone) has shown to be an effective treatment for chronic long-term opioid dependency. Illicit opioid use is associated with severe psychosocial problems such as homelessness, Data suggest that women who are injection drug users (IDU) and engage in sex work present greater vulnerabilities compared to non-sex workers using injection drugs They are more likely to have unstable housing [4,10], higher rates of incarceration [4,10,11,12] and fewer years of education [12]. Chronic health conditions and infectious diseases, such as human immunodeficiency virus (HIV) infection [14,15], hepatitis C [16] and sexually transmitted infections (STI) are highly prevalent among female sex workers using injection drugs This has been supported by studies showing that HIV risk behaviours, including sharing injection equipment [4,10,11,17] and inconsistent condom use with clients [10,17] are common risk behaviours. In a sample of injection drug using women accessing MMT [12], it was determined that sex workers had greater psychological symptoms including depression, anxiety, psychosis and hostility, compared to women not involved in sex work

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