Sex work involvement among women with longterm opioid injection drug dependence who enter opioid agonist treatment
Date
2012-01-25
Authors
Marchand, Kirsten
Oviedo-Joekes, Eugenia
Guh, Daphne
Marsh, David C.
Brissette, Suzanne
Schechter, Martin T
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: Substitution with opioid-agonists (e.g., methadone) has shown to be an effective treatment for
chronic long-term opioid dependency. Survival sex work, very common among injection drug users, has been
associated with poor Opioid Agonist Treatment (OAT) engagement, retention and response. Therefore, this study
was undertaken to determine factors associated with engaging in sex work among long-term opioid dependent
women receiving OAT.
Methods: Data from a randomized controlled trial, the North American Opiate Medication Initiative (NAOMI),
conducted in Vancouver and Montreal (Canada) between 2005-2008, was analyzed. The NAOMI study compared
the effectiveness of oral methadone to injectable diacetylmorphine or injectable hydromorphone, the last two on a
double blind basis, over 12 months. A research team, independent of the clinic services, obtained outcome
evaluations at baseline and follow-up (3, 6, 9, 12, 18 and 24 months).
Results: A total 53.6% of women reported engaging in sex work in at least one of the research visits. At treatment
initiation, women who were younger and had fewer years of education were more likely to be engaged in sex
work. The multivariate logistic generalized estimating equation regression analysis determined that psychological
symptoms, and high illicit heroin and cocaine use correlated with women’s involvement in sex work during the
study period.
Conclusions: After entering OAT, women using injection drugs and engaging in sex work represent a particularly
vulnerable group showing poorer psychological health and a higher use of heroin and cocaine compared to
women not engaging in sex work. These factors must be taken into consideration in the planning and provision of
OAT in order to improve treatment outcomes.
Trial Registration: NCT00175357.
Description
BioMed Central
Keywords
Sex work, opioid dependence, substitution treatment
Citation
Marchand et al.: Sex work involvement among women with long-term opioid injection drug dependence who enter opioid agonist treatment. Harm Reduction Journal 2012 9:8.