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

Abstract

Background 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. 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. Methods Survey 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. Results Among 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. Conclusions We 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.

Injecting drugs alone during an overdose crisis in Vancouver, Canada

“…We considered Indigenous ancestry (self-identified vs. other) given evidence indicating that PWUD of Indigenous ancestry experience a disproportionate burden of overdose and other drug-related harms [ 12 , 25 ]. Other time-fixed characteristics considered included: age (per year older), sex (male vs. female); sexual orientation, defined as lesbian, gay, bisexual, Two-Spirit, or other vs. straight; relationship status, defined as legally married, common law, or regular partner vs. other; depression symptomology, measured using the Center for Epidemiological Studies Depression Scale (CES-D) (≥ 22 vs. < 22) at baseline; and posttraumatic stress disorder (PTSD), measured one time using the PTSD Checklist for DSM -5 (PCL-5) (≥ 31 vs. < 31) [ 16 ]. Characteristics measured in the previous 6 months at each study interview that we considered included: employment, defined as income generation from a regular or temporary job or self-employment (yes vs. no); homelessness (yes vs. no), defined as being without any shelter; Downtown Eastside (DTES) residence (yes vs. no), a neighbourhood in Vancouver that is disproportionately affected by overdose deaths [ 44 ]; incarceration (yes vs. no); sex work, defined as exchanging sex for money, gifts, food, shelter, clothes, etc.…”

Posttraumatic stress disorder in people who use drugs: syringe services program utilization, treatment need, and preferences for onsite mental health care

“…Symptoms include re-experiencing the traumatic event, avoiding trauma reminders, negative alterations in mood and thought, and heightened arousal and reactivity [1]. PTSD is one of the most common psychiatric comorbidities in people who use drugs (PWUD) with prevalence estimates ranging between 21% and 40% [2][3][4][5]. From a risk environment framework [6], this disproportionately high PTSD rate can be understood as a product of the social situations and structures PWUD inhabit (e.g.…”

“…This suggests that PWUD living with PTSD may recognize their need for OUD care but face unique barriers to treatment. These barriers might arise from PTSD symptoms themselves, such as intrusive memories, avoidance, and emotion dysregulation, which together may make navigating complex health systems, tolerating long waiting times, and enduring stigma particularly difficult [2,14]. Engagement in the conventional health care system for OUD care is, therefore, challenging for individuals with comorbid PTSD and OUD.…”

“…We thus expected to find elevated rates of trauma and PTSD and significant unmet PTSD treatment needs in this sample of SSP clients. Additionally, we hypothesized that a provisional PTSD diagnosis would be predictive of lower OUD, PTSD, and SSP services utilization [2,13,31]. Our question about attitudes toward mental health care onsite at SSPs was exploratory.…”

Posttraumatic stress disorder in people who use drugs: Syringe services program utilization, treatment need, and preferences for onsite mental health care

“…Multiple barriers also prevent PWUD from accessing traditional sites for PTSD care, tolerating long waiting times, and enduring stigma particularly difficult (2,14). For those with PTSD AT SYRINGE SERVICE PROGRAMS 4 comorbid substance use problems, the wide availability of specialized PTSD care remains limited outside of the Veterans Administration system (15).…”