The impact of PSTD on service access among people who use drugs in Vancouver, Canada

Annemarie Goytan,Thomas Kerr,M J Milloy,Kanna Hayashi,William Lee,Huiru Dong

doi:10.1186/s13011-021-00390-x

Abstract

BackgroundSettings throughout the United States and Canada are contending with high rates of drug-related overdose. This in turn has prompted efforts to more effectively engage people who use drugs (PWUD) in treatment and care. However, while co-morbid mental disorders are prevalent among PWUD and can undermine access to services, the impact of post-traumatic stress disorder (PTSD) on service access is not known. Therefore, we sought to assess whether PTSD is associated with difficulties accessing health and social services among PWUD in Vancouver, Canada.MethodsSurvey data was derived from two prospective cohorts of PWUD in Vancouver, Canada for the period of April 2017 to November 2018. PTSD was assessed using the PTSD Checklist for the DSM-V (PCL-5). Generalized estimating equations (GEE) was used to estimate the relationship between PTSD and self-reported inability to access health and social services, after adjustment for confounders.ResultsAmong 810 participants included in our analysis, 316 (39.0%) participants qualified for a provisional PSTD diagnosis, and 117 (14.4%) reported difficulties accessing services. In a multivariable GEE analysis, a PTSD diagnosis (adjusted odds ratio = 1.69, 95% confidence interval: 1.12–2.55) was independently associated with difficulties accessing services.ConclusionsWe found high rates of PTSD and self-reported difficulties accessing services among PWUD in Vancouver, as well as a positive association between PTSD and difficulties with service access. These findings highlight the need for trauma-informed approaches to service delivery for PWUD, as well as enhanced provider training specific to PTSD.

Highlights

Settings throughout the United States and Canada continue to experience unprecedented levels of opioid overdoses driven largely by the increasing presence of synthetic fentanyl and related substances
Of particular concern is the high rate of post-traumatic stress disorder (PTSD) among people who use drugs (PWUD)
Our study aims to assess whether trauma, operationalized by a provisional PTSD diagnosis, is associated with the inability to access services for PWUD

Summary

Introduction

Settings throughout the United States and Canada continue to experience unprecedented levels of opioid overdoses driven largely by the increasing presence of synthetic fentanyl and related substances. Comorbid mental disorders are prevalent among people who use drugs (PWUD) and are known to be associated with suboptimal health and social service access, poor treatment retention and outcomes, as well as elevated overdose risk [3, 9, 10, 20]. Settings throughout the United States and Canada are contending with high rates of drug-related overdose This in turn has prompted efforts to more effectively engage people who use drugs (PWUD) in treatment and care. We sought to assess whether PTSD is associated with difficulties accessing health and social services among PWUD in Vancouver, Canada

Methods

Results

Conclusion