Patterns of Substance Use and Mental Health Among Immigrants in Canada During COVID-19: A Latent Class Analysis.

Immigrants in Canada may have been particularly vulnerable to substance use during the COVID-19 pandemic due to heightened psychological distress from intensified marginalization. Research on substance use in this population during global crises remains limited. This study examines patterns of substance use and how these patterns vary by self-perceived mental health status.. This cross-sectional study used data from Cycle 6 of the Canadian Perspectives Survey Series, Substance Use and Stigma During the Pandemic, conducted from January 25 to 31, 2021. The sample included 651 immigrants aged 15 and older. Latent class analysis and logistic regression models were used to identify patterns of substance use and to investigate the association between self-perceived mental health status and substance use patterns. Most immigrants (85.2%, n = 555) were low-use, with low probabilities of opioid (2.1%), cannabis (9.7%), and non-prescription drug use (2.1%), and moderate alcohol use (50.7%). A smaller group (14.8%, n = 96) was higher-use, with higher probabilities of opioid (13.2%), cannabis (66.5%), and non-prescription drug use (11.8%), and near-universal alcohol use (99.9%). Immigrants with lower self-perceived mental health status were more likely to belong to the higher-use substance class, characterized by multiple and more addictive substances (AOR = 2.10, 95% CI [1.28, 3.41], p < .01). Among the covariates included in the model, only marital status was significantly associated with substance use class membership (AOR = 2.50, 95% CI [1.58, 3.96], p < .001), while other covariates showed no significant association. Immigrants in Canada are particularly vulnerable to substance use during the COVID-19 pandemic, possibly due to lower self-perceived mental health status. Marginalized identities, acculturation stress, and the accelerated erosion of the Healthy Immigrant Effect may contribute to the adoption of host-country substance use behaviours, while increased barriers to accessing treatment heighten the risk of substance use-related harms and exacerbate health inequities, particularly during global crises such as the pandemic. These findings highlight disparities in substance use-related health outcomes among immigrants and underscore the urgent need for accessible, culturally responsive health services and social support to address substance use and mental health challenges in this population during future crises.