社区给药纳洛酮逆转用药过量：性工作者主导的规划和职业暴力在社区队列中的作用（2018-2024）

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-04-01 DOI:10.1016/j.drugpo.2025.104784

Sarah Moreheart , Kate Shannon , Kanna Hayashi , Wiebke Bartels , Andrea Krüsi , Shira Miriam Goldenberg

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引用次数: 0

摘要

背景：在持续的有毒药物危机中，使用药物的性工作者面临过量服用的高风险，同时在减少伤害服务方面存在结构性障碍。先前的研究指出，职业暴力和同伴主导的项目会影响性工作者的健康结果。考虑到社区给药带回家纳洛酮（THN）有可能减少过量相关的危害，我们评估了5.5年（2018-2024）期间纳洛酮给药的纵向趋势和吸收情况，以及暴露于性工作特定项目与THN给药的职业暴力和骚扰之间的关系。方法数据来源于性工作者健康准入评估，这是一项2018年9月至2024年3月期间加拿大温哥华的前瞻性社区性工作者队列研究。我们绘制了THN给药的半年趋势（目的1），并使用双变量逻辑回归和广义估计方程（GEE）来描述THN给药的摄取（目的2）。最后，我们使用双变量和多变量GEE来评估暴露于性工作特定项目与THN给药的职业暴力和骚扰之间的关系（目的3）。结果在427名参与者中，57.9% （N = 247）报告至少服用过一次THN。暴露于性工作特定项目与THN管理密切相关（调整优势比[AOR] 1.26, 95%可信区间[CI] 1.02-1.55），暴露于客户暴力（AOR 1.72, 95% CI 1.22-2.41）和社区（AOR 1.76, 95% CI 1.25-2.46），以及警察骚扰（AOR 1.54, 95% CI 1.07-2.21）。在5.5年的时间里，超过一半的参与者接受了THN治疗，这与暴露于性工作特定项目和职业暴力有关。来自客户、社区成员和警察的暴力行为单独增加了THN管理的可能性。研究结果表明，被边缘化的性工作者，特别是那些在职业环境中使用药物的人，在应对过量用药方面处于独特的地位。这支持了实施针对性工作者的过量干预措施的可行性，并强调了扩大以社区为基础、性工作者主导的安全、暴力预防和护理干预措施的必要性，以加强过量预防工作，改善纳洛酮级联指标。

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Community-administered naloxone for overdose reversal: The role of sex worker-led programming and occupational violence in a community-based cohort (2018–2024)

Background

Amidst the ongoing toxic drug crisis, sex workers who use drugs face high overdose risk alongside structural barriers to harm reduction services. Previous work has noted that occupational violence and peer-led programs can influence health outcomes for sex workers. Given the potential for community-administered take-home naloxone (THN) to reduce overdose-related harm, we evaluated longitudinal trends and uptake of THN administration, and the associations between exposure to sex work-specific programs and occupational violence and harassment with THN administration over 5.5-years (2018–2024).

Methods

Data was derived from An Evaluation of Sex Workers’ Health Access, a prospective, community-based cohort of sex workers in Vancouver, Canada from September 2018-March 2024. We plotted semi-annual trends of THN administration (Aim 1) and used bivariate logistic regression with generalized estimating equations (GEE) to characterize uptake of THN administration (Aim 2). Lastly, we employed bivariate and multivariable GEE to evaluate the association between exposure to sex-work specific programs and occupational violence and harassment with THN administration (Aim 3).

Results

Among 427 participants, 57.9 % (N = 247) reported administering THN at least once. Exposure to sex work-specific programs was strongly associated with THN administration (Adjusted Odds Ratio [AOR] 1.26, 95 % Confidence Interval [CI] 1.02–1.55), as was exposure to violence from clients (AOR 1.72, 95 %CI 1.22–2.41) and community (AOR 1.76, 95 %CI 1.25–2.46), and police harassment (AOR 1.54, 95 %CI 1.07–2.21).

Conclusion

Over 5.5 years, over half of participants administered THN, which was associated with exposure to sex work-specific programs and occupational violence. Violence from clients, community members, and police independently increased the likelihood of THN administration. Findings suggest that marginalized sex workers, particularly those who use drugs in occupational settings, are uniquely positioned to respond to overdoses. This supports the feasibility of implementing sex worker-specific overdose interventions and highlights the need to expand community-based, sex worker-led safety, violence prevention, and care interventions to strengthen overdose prevention efforts and improve naloxone cascade metrics.

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.