Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada

• Nearly one-fifth of sex workers report nonmedical prescription opioid use (NPOU).
• Partner violence and police harassment were independently correlated with recent NPOU.
• Further prevention/management strategies tailored to this population are needed.
• This is the first study to longitudinally examine NPOU among sex workers in Canada.

BackgroundThe nonmedical use of prescription opioids (POs) is a major public health concern, causing extensive morbidity and mortality in North America. Canada has the second highest consumption rate of POs globally and data indicate nonmedical PO use (NPOU) is growing among key populations and increasingly available in street-level drug markets. Despite accumulating evidence documenting the rise of NPOU, few studies have systematically examined NPOU in Canada among key vulnerable populations, such as sex workers. This study prospectively evaluated the prevalence and correlates of NPOU within a Vancouver cohort of sex workers over three-years follow-up.MethodsData were drawn from an open prospective cohort, AESHA (An Evaluation of Sex Workers Health Access) in Metro Vancouver, Canada (2010–2013). Women were recruited through outreach from outdoor street locations and indoor venues. Bivariate and multivariable logistic regression using Generalized Estimating Equations (GEE) were used to examine social and structural correlates of NPOU over 36 months.ResultsOf the 692 sex workers at baseline, close to one-fifth (n = 130, 18.8%) reported NPOU (injection or non-injection) in the last six months. In multivariable GEE analyses, factors independently correlated with recent NPOU were: exchanging sex while high (AOR 3.26, 95%CI 2.29–4.64), police harassment/arrest (AOR 1.83, 95%CI 1.43–2.35), intimate partner injects drugs (AOR 1.66, 95%CI 1.11–2.49), and recent physical/sexual intimate partner violence (AOR 1.65, 95%CI 1.21–2.24).ConclusionOur results demonstrate that nearly one-fifth of sex workers in Metro Vancouver report NPOU. Factors independently statistically associated with NPOU included exchanging sex while high, police harassment/arrest, a drug injecting intimate partner and recent physical/sexual intimate partner violence. The high prevalence of NPOU use among sex workers underscores the need for further prevention and management strategies tailored to this key population. The correlates of NPOU uncovered here suggest that structural interventions may be further implemented to ameliorate this growing concern.