ArticleThe International journal on drug policy2023
Association of sex work and social-structural factors with non-fatal overdose among women who use drugs in Vancouver, Canada.
Article in The International journal on drug policy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis.Harm reduction journal · 2024Pooled it
- Take-home naloxone (THN) ownership among a community-based cohort of sex workers who use drugs in metro vancouver: longitudinal trends and structural determinants (2017-2024).Harm reduction journal · 2026Article
- Use of clinic- and community-based overdose prevention services by sex workers who use drugs: findings from a community-based cohort in Vancouver, Canada (2017-2024).Harm reduction journal · 2026Article
- What we need, not what we're given: recommendations for action from young sex workers who use drugs.Harm reduction journal · 2026Article
- Spatial epidemiology of nonfatal overdose in a community-based cohort of marginalized women in Vancouver, British Columbia (2014-2022).Drug and alcohol dependence · 2025Article
- Fostering Safety, Support, and Hope: A Qualitative Study of Multistakeholder Perspectives on Designing Health Care Services for Women Who Use Drugs in Seattle, Washington, 2023.Women's health reports (New Rochelle, N.Y.) · 2025Article
- PrEP facilitators and barriers in substance use bridge clinics for women who engage in sex work and who use drugs.Addiction science & clinical practice · 2024Article
- Negative changes in illicit drug supply during COVID-19: Associations with use of overdose prevention and health services among women sex workers who use drugs (2020-2021).The International journal on drug policy · 2023Article
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Authors and funding
9 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundWomen who use drugs (WWUD) and engage in sex work experience disproportionate sex- and drug-related harms, such as HIV, however comparatively little is known about their overdose risk. Therefore, we examined the association between sex work and overdose and secondarily explored the association of social-structural factors, such as policing and gendered violence, with overdose.
methodsData were derived from two community cohort studies based in Vancouver, Canada between 2005 to 2018. We used logistic regression with GEE to examine the associations between a) sex work and nonfatal overdose and b) social-structural and individual variables with overdose among WWUD who engaged in sex work during the study. Sex work, overdose, and other variables were time-updated, captured every six months.
resultsAmong 857 WWUD included, 56% engaged in sex work during the study. Forty-three percent of WWUD engaged in sex work had at least one overdose compared to 26% of WWUD who did not. Sex work was not significantly associated with an increased odds of overdose (AOR = 1.14, 95% CI: 0.93-1.40). In the exploratory analysis amongst 476 WWUD engaged in sex work, social-structural variables associated with overdose in the multivariable model included exposure to: punitive policing (OR = 1.97, 95% CI: 1.30-2.96) and physical or sexual violence (OR = 2.55, 95% CI: 1.88-3.46).
conclusionsWWUD engaged in sex work had an increased overdose burden that may be driven by social-structural factors rather than sex work itself. Interventions that address policing and gendered violence represent potential targets for effective overdose prevention.
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