Titre : | Drug-related harm coinciding with income assistance payments: results from a community-based cohort of people who use drugs (2021) |
Auteurs : | L. RICHARDSON ; H. DONG ; T. KERR ; M. J. MILLOY ; K. HAYASHI |
Type de document : | Article : Périodique |
Dans : | Addiction (Vol.116, n°3, March 2021) |
Article en page(s) : | 536-545 |
Note générale : | Commentary: Strategies to mitigate payment-coincident drug-related harms are urgently needed. Macmadu A., Rich J.D., p. 546-547. https://doi.org/10.1111/add.15325 |
Langues: | Anglais |
Discipline : | EPI (Epidémiologie / Epidemiology) |
Mots-clés : |
Thésaurus géographique CANADAThésaurus mots-clés ALLOCATION ; REVENU ; ETUDE LONGITUDINALE ; PRODUIT ILLICITE ; USAGER ; PAUVRETE ; PREVALENCE ; SANS ABRI ; COHORTE |
Résumé : |
BACKGROUND AND AIMS: Income assistance is critical to the health and wellbeing of socio-economically marginalized people who use illicit drugs (PWUD). However, past literature paradoxically identifies unintended increases in drug-related harm coinciding with synchronized payments that may magnify signals for drug use. The scope of such harm has not been fully characterized among non-institutionalized populations. This study examined socio-demographic, health and drug use-related correlates of payment-coincident drug-related harm.
DESIGN: This observational study uses data from prospective community-based longitudinal cohorts of PWUD between December 2013 and May 2018. SETTING: Vancouver, British Columbia, Canada. PARTICIPANTS: A total of 1604 PWUD receiving monthly income assistance. Our sample included 586 (36.5%) women, 861 (53.7%) non-white participants and 685 (42.7%) people living with HIV. MEASUREMENTS: The primary outcome was a self-reported composite measure of drug-related harm in the past 6 months coinciding with income assistance, including higher-frequency substance use, non-fatal overdose and service barriers or interruptions. Subanalyses disaggregated this outcome. FINDINGS: Payment-coincident drug-related harm was reported among 77.7% of participants during the study period. In multivariable models, key correlates positively and significantly associated with payment-coincident harm included: street-based income generation [adjusted odds ratio (aOR) = 1.48, 95% confidence interval (CI) = 1.26-1.74, P < 0.001], sex work (aOR = 1.66, 95% CI = 1.35-2.04, P < 0.001), illegal income generation (aOR = 1.57, 95% CI = 1.35-1.83 P < 0.001), homelessness (aOR = 1.34, 95% CI = 1.13-1.58, P < 0.001), exposure to violence (aOR = 1.31, 95% CI = 1.03-1.66, P = 0.032), daily crack cocaine use (aOR = 1.99, 95% CI = 1.59-2.50, P < 0.001), heavy alcohol use (aOR = 1.64, 95% CI = 1.37-1.97, P < 0.001) and injection drug use (aOR = 2.55, 95% CI = 2.01-3.23, P < 0.001). In subanalyses, specific harms were more likely among individuals reporting social, structural and health vulnerabilities. CONCLUSIONS: In Vancouver, Canada, people who use illicit drugs who receive income assistance report high prevalence of payment-coincident drug-related harm, particularly people experiencing socioeconomic and structural marginalization or engaging in high-intensity drug use. |
Domaine : | Alcool / Alcohol ; Drogues illicites / Illicit drugs |
Refs biblio. : | 77 |
Affiliation : | British Columbia Centre on Substance Use, Vancouver, BC, Canada |
Cote : | Abonnement |
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