Sex work involvement among women with long-term opioid injection drug dependence who enter opioid agonist treatment

Data from a randomized controlled trial, the North American Opiate Medication Initiative (NAOMI), conducted in Vancouver and Montreal (Canada) between 2005-2008, was analyzed. The NAOMI study compared the effectiveness of oral methadone to injectable diacetylmorphine or injectable hydromorphone, the last two on a double blind basis, over 12 months. A research team, independent of the clinic services, obtained outcome evaluations at baseline and follow-up (3, 6, 9, 12, 18 and 24 months).A total 53.6% of women reported engaging in sex work in at least one of the research visits. At treatment initiation, women who were younger and had fewer years of education were more likely to be engaged in sex work. The multivariate logistic generalized estimating equation regression analysis determined that psychological symptoms, and high illicit heroin and cocaine use correlated with women's involvement in sex work during the study period.After entering OAT, women using injection drugs and engaging in sex work represent a particularly vulnerable group showing poorer psychological health and a higher use of heroin and cocaine compared to women not engaging in sex work. These factors must be taken into consideration in the planning and provision of OAT in order to improve treatment outcomes.NCT00175357.Opioid dependence, frequently manifested as heroin dependence, is a chronic illness that, when untreated, can result in adverse health consequences such as blood-borne viral infections, endocarditis and drug overdoses [1,2]. Illicit opioid use is also associated with severe psychosocial problems such as homelessness, unemployment, loss of family bonds, and illegal activity [3]. Survival sex work is very common among street drug users and has been associated with increased drug related harms [4-7]. Although data indicate that women as well as men using drugs engage in sex work, women who use injection drugs are more likely to be involved in survival sex work compared to men [4,8,9].Da