Harm reduction journal · 2026
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).
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Moreheart Sarah, Shannon Kate, Krüsi Andrea, Bartels Wiebke, Zhou Haoxuan, Hayashi Kanna, Luba Emily, Merrison Colette, Goldenberg Shira Miriam
Аннотация
BACKGROUND: Sex workers who use drugs face disproportionately high overdose burden, driven by drug toxicity and intersecting structural factors in sex work and drug use environments. Given limited evidence regarding sex workers' use of overdose prevention tools, including take-home naloxone (THN), we examined period prevalence, time trends, and structural factors longitudinally associated with THN ownership among sex workers over 7 years.
METHODS: Data derived from An Evaluation of Sex Workers' Health Access, a prospective, community-based cohort of sex workers in Vancouver, Canada (March 2017-March 2024). Generalized linear mixed-effects modeling (GLMM) examined structural factors associated with THN ownership.
RESULTS: Among 506 participants, 90.3% (N = 457) ever owned THN. Period prevalence of THN ownership remained high across semi-annual visits( 72.6-88.8%). In multivariable GLMM modeling, THN ownership was associated with injection drug use (Adjusted Odds Ratio [AOR] 1.70, 95% Confidence Interval [CI] 1.35-2.14), enrollment in opioid agonist therapy (AOR 1.60, 95% CI 1.29-1.98), and drug use with sex work clients (AOR 1.27, 95% CI 1.02-1.59); whereas recent homelessness was associated with lower odds of THN ownership (AOR 0.52, 95% CI 0.37-0.73). Having used sex work-specific programs was marginally associated with higher odds of THN ownership.
CONCLUSION: The majority of sex workers in this study owned THN, with high prevalence sustained over time. Ownership was particularly associated with enrollment in opioid agonist therapy and drug use with clients. However, recent homelessness was a barrier to THN ownership. Findings highlight the importance of integrating THN distribution and training into sex work-specific programs, with a focus on enhancing access to treatment and addressing structural factors that impact both safety and overdose prevention. Ensuring sex workers' right to health via strengthening THN access and equity-driven harm reduction strategies that prioritize the most marginalized sex workers is recommended.
METHODS: Data derived from An Evaluation of Sex Workers' Health Access, a prospective, community-based cohort of sex workers in Vancouver, Canada (March 2017-March 2024). Generalized linear mixed-effects modeling (GLMM) examined structural factors associated with THN ownership.
RESULTS: Among 506 participants, 90.3% (N = 457) ever owned THN. Period prevalence of THN ownership remained high across semi-annual visits( 72.6-88.8%). In multivariable GLMM modeling, THN ownership was associated with injection drug use (Adjusted Odds Ratio [AOR] 1.70, 95% Confidence Interval [CI] 1.35-2.14), enrollment in opioid agonist therapy (AOR 1.60, 95% CI 1.29-1.98), and drug use with sex work clients (AOR 1.27, 95% CI 1.02-1.59); whereas recent homelessness was associated with lower odds of THN ownership (AOR 0.52, 95% CI 0.37-0.73). Having used sex work-specific programs was marginally associated with higher odds of THN ownership.
CONCLUSION: The majority of sex workers in this study owned THN, with high prevalence sustained over time. Ownership was particularly associated with enrollment in opioid agonist therapy and drug use with clients. However, recent homelessness was a barrier to THN ownership. Findings highlight the importance of integrating THN distribution and training into sex work-specific programs, with a focus on enhancing access to treatment and addressing structural factors that impact both safety and overdose prevention. Ensuring sex workers' right to health via strengthening THN access and equity-driven harm reduction strategies that prioritize the most marginalized sex workers is recommended.