Substance Use and Access to Health Care and Addiction Treatment among Homeless and Vulnerably Housed Persons in Three Canadian Cities

Abstract

IntroductionWe examined the prevalence of substance use disorders among homeless and vulnerably housed persons in three Canadian cities and its association with unmet health care needs and access to addiction treatment using baseline data from the Health and Housing in Transition Study.MethodsIn 2009, 1191 homeless and vulnerably housed persons were recruited in Vancouver, Toronto, and Ottawa, Canada. Interviewer administered questionnaires collected data on socio-demographics, housing history, chronic health conditions, mental health diagnoses, problematic drug use (DAST-10≥6), problematic alcohol use (AUDIT≥20), unmet physical and mental health care needs, addiction treatment in the past 12 months. Three multiple logistic regression models were fit to examine the independent association of substance use with unmet physical health care need, unmet mental health care need, and addiction treatment.ResultsSubstance use was highly prevalent, with over half (53%) screening positive for the DAST-10 and 38% screening positive for the AUDIT. Problematic drug use was 29%, problematic alcohol use was lower at 16% and 7% had both problematic drug and alcohol use. In multiple regression models for unmet need, we found that problematic drug use was independently associated with unmet physical (adjusted odds ratio [AOR] 1.95; 95% confidence interval [CI] 1.43–2.64) and unmet mental (AOR 3.06; 95% CI 2.17–4.30) health care needs. Problematic alcohol use was not associated with unmet health care needs. Among those with problematic substance use, problematic drug use was associated with a greater likelihood of accessing addiction treatment compared to those with problematic alcohol use alone (AOR 2.32; 95% CI 1.18–4.54).ConclusionsProblematic drug use among homeless and vulnerably housed individuals was associated with having unmet health care needs and accessing addiction treatment. Strategies to provide comprehensive health services including addiction treatment should be developed and integrated within community supported models of care.

Substance use among Persons with Homeless Experience in Primary Care

“…5--10 However, detailed data on SUD among homeless-experienced persons in primary care are lacking. One study of homeless patients at Federally Qualified Health Centers (FQHCs) reported dependence prevalence of 12-15% and binge drinking in 40%.…”

Peer helpers’ struggles to care for “others” who inject drugs

“…As might be expected, marginalized populations have been particularly affected by declining government expenditures on health care and physician shortages (Asanin & Wilson, 2008;Crooks, Agarwal, & Harrison, 2012;Khandor et al, 2011;Palepu et al, 2013). Furthermore, well publicized linkages between what are presented as "life-style choices" and illness position those who do not make "correct" choices as irresponsible citizens.…”

Mental Illness and Substance Use Problems in Relation to Homelessness Onset

“…[13][14][15] Homeless youth, similar to their adult counterparts, also tend to abuse substances at higher rates than their housed peers. [16][17][18] For example, one study of homeless youth concluded that about 75% of those surveyed met the clinical criteria for having a drug and/or alcohol use disorder. 19 According to other studies, 57%-70% of homeless youth reported recent use of alcohol, 20 57%-68% reported recent use of marijuana, 20 and 50% reported prescription drug misuse, 21 rates that are higher than those found in the general population.…”