Income generation and attitudes towards addiction treatment among people who use illicit drugs in a Canadian setting

Abstract

Introduction Socioeconomically marginalized people who use illicit drugs (PWUD) often engage in alternative income generating activities to meet their basic needs. These activities commonly carry a number of health and social risks, which may prompt some PWUD to consider addiction treatment to reduce their drug use or drug-related expenses. We sought to determine whether engaging in certain forms of income generation was independently associated with self-reported need for addiction treatment among a cohort of PWUD in Vancouver, Canada. Methods Data from two prospective cohorts of PWUD in Vancouver were used in generalized estimating equations to identify factors associated with self-reported need for addiction treatment, with a focus on income generating activities. Results Between June 2013 and May 2014, 1285 respondents participated in the study of whom 483 (34.1%) were female and 396 (30.8%) indicated that they needed addiction treatment. In final multivariate analyses, key factors significantly and positively associated with self-reported need for addiction treatment included engaging in illegal income generating activities (adjusted odds ratio [AOR] = 1.96, 95% Confidence Interval [CI}: 1.11-3.46); sex work (AOR = 1.61, 95% CI: 1.05-2.47), homelessness (AOR = 1.65, 95% CI: 1.22-2.25); and recent engagement in counselling (AOR = 1.85, 95% CI: 1.40-2.44). Discussion Our results suggest that key markers of socioeconomic marginalization are strongly linked with a stated need for addiction treatment. These findings underscore the need to provide appropriate and accessible addiction treatment access to marginalized PWUD and to consider alternative approaches to reduce socioeconomic disadvantage.

Is precariousness the blind spot of prevention and treatment of the use of psychoactive substances?

“…Less consideration has been given to their in uence on the initiation of drug use, on its course and to the access to health services. Targeting at risk DU, many surveys are unable to give a global understanding of its in uence on the initiation of drug use, on its course and to the access to health services (11)(12)(13)(14)(15). Like the majority of the studies of DUs, as is the case of surveys of the prevalence of hepatitis (16,17), the bulk of French publications (18,19) concern services for DUs, ignore GP's who prescribe 2/3 of the opioid substitution treatments (20), and ignore UDs outside these dedicated health services.…”