Receipt of COVID-19 emergency funds and engagement in sex work during COVID-19 among people who use drugs: evidence from Vancouver, Canada.

BACKGROUND: During the early period of the COVID-19 pandemic, public health orders disrupted income generation in numerous sectors and many governments provided emergency financial support. Access to government support and changes in engagement in sex work during the early period of the pandemic among people who use drugs (PWUD) are not well described. In the present study, we investigate the prevalence and correlates of engaging in sex work during the COVID-19 pandemic, among PWUD in Vancouver, Canada. METHODS: Data derived from three harmonized cohorts of PWUD. Using multivariable logistic regression, we characterized factors associated with engaging in sex work in the last month between July 17 and November 30, 2020. Reports of changes in frequency of engagement in sex work since the pandemic were also collected. RESULTS: Of the 864 individuals included in this analysis, 55 (6.4%) reported sex work engagement in the last month. Among these participants, 40.7% reported receiving COVID-19 income support in the past month vs. 52.7% of the rest of the sample, though receipt of income support in the past six months was similar between the two groups (72.2% vs. 75.7%, p = 0.624). In multivariable analysis, receipt of financial support in the last month was negatively associated with engagement in sex work in the last month (adjusted odds ratio [AOR] = 0.44 [95% confidence interval [CI]: 0.24-0.81]). Among 69 participants who responded to a question regarding changes in engagement in sex work, 38 (55.1%) reported a decrease, 11 (15.9%) reported an increase, 19 (27.5%) reported no change, and 1 (1.4%) reported cessation. CONCLUSIONS: Findings document that engagement in sex work appears to have declined early in the pandemic. Participants who received income support in the past month were less likely to report recent engagement in sex work. Findings suggest that recent receipt of income support may have contributed to reductions in engagement in sex work. Additional investigation is warranted.

COVID-19 vaccination among young people who use drugs in Vancouver, Canada.

OBJECTIVES: SARS-CoV-2 vaccines provide significant protection against severe illness and death from COVID-19, in addition to reducing community transmission. Emerging research has identified factors associated with vaccine uptake among adults who use drugs; however, less is known about youth and young adults who use drugs (YWUD). To address this gap, we sought to characterize factors associated with vaccine uptake and explore vaccine hesitancy among YWUD. METHODS: Data were derived from the At-Risk Youth Study, a prospective cohort of street-involved YWUD in Vancouver, Canada. Using multivariable logistic regression, we characterized factors associated with SARS-CoV-2 vaccine uptake between June and November 2021. Data on vaccine hesitancy were also collected. RESULTS: Among 301 participants enrolled in this study (median age: 29 [min and max: 20-40]), 151 (50.2%) self-reported receipt of at least one dose of a SARS-CoV-2 vaccine. In multivariable analysis, vaccine uptake was significantly associated with recent addiction treatment engagement (adjusted odds ratio [AOR] = 2.46, 95% confidence interval [CI]: 1.47-4.14) and receiving prescribed safer supply (e.g., opioids, stimulants) (AOR = 2.33, 95% CI: 1.03-5.62). Those who reported at least weekly crack use were significantly less likely to be vaccinated (AOR = 0.35, 95% CI: 0.12-0.92). The most reported reason for vaccine hesitancy was safety concerns, specifically regarding long-term side effects (27.4%). CONCLUSION: Vaccine uptake was significantly lower among YWUD than adults who use drugs in Vancouver and the general population in British Columbia, among whom 75% and 93% received at least one dose during the same period. Study findings suggest connecting YWUD to healthcare and novel harm reduction interventions may increase vaccine uptake. Responses to vaccine hesitancy questions revealed complex perspectives of vaccines that were aligned with sources of vaccine hesitancy among the general population. Broader strategies combatting misinformation and promoting evidence-based vaccine information could be tailored to address the unique needs and barriers experienced by YWUD.

Decriminalization thresholds for drug possession: A multi-criteria policy analysis framework.

BACKGROUND: Decriminalization of personal possession of drugs has been proposed as an approach to mitigate the harms of drug prohibition. Despite growing interest, particularly in Canadian settings, analyses of approaches to defining the parameters of what constitutes personal possession within decriminalization models are lacking. Using the Province of British Columbia, Canada, as a case study, we undertook an evidence-based multi-criteria policy analysis of three models for defining personal possession: 1) a model that defines personal possession as the absence of evidence of drug trafficking; 2) a cumulative threshold of 15 grams; and 3) a cumulative threshold of 2.5 grams. METHODS: We utilized data from four sources: qualitative interviews with 16 experts, including representatives from government and law enforcement; Vancouver Police drug seizure data; self-reported drug consumption data from longitudinal cohorts of people who use drugs in Vancouver; and publicly available government documents (e.g., the Government of BC's submission for decriminalization). Data was used to identify and define evaluation criteria which reflect the stated policy objectives of decriminalization alongside other policy considerations. This framework was used to conduct a multi-criteria policy analysis of the three different models. RESULTS: The seven evaluation criteria included: 1) reduction in interactions with police; 2) reduction of police drug seizures; 3) coverage for those with high consumption; 4) impact on equity-deserving groups; and acceptance on the part key stakeholders, including: 5) people who use drugs; 6) law enforcement; and 7) the public. The model that performed the best was the cumulative threshold model of 15 grams. CONCLUSION: Findings highlight that different threshold models advance and constrain the stated policy objectives of drug decriminalization to varying degrees. This analysis provides a framework that other jurisdictions considering decriminalization could use to help inform determinations of threshold levels based on stated policy objectives.

Factors associated with perceived decline in the quality of drugs during the COVID-19 pandemic: Evidence from community-recruited cohorts of people who use drugs in Vancouver, Canada.

OBJECTIVES: Driven by an increasingly toxic drug supply, drug toxicity deaths in the United States and Canada have risen to unprecedented levels during the COVID-19 pandemic. This study aimed to characterize the prevalence of and the factors associated with a perceived decline in the quality of drugs during the COVID-19 pandemic among community-recruited cohorts of PWUD in Vancouver, Canada. METHODS: Data collection took place between July and November 2020. In adherence with COVID-19 safety protocols, questionnaires were administered by interviewers through remote means (e.g., phone or videoconference). Using multivariable logistic regression, we characterized the prevalence of and factors associated with a perceived decline in drug quality during the start of the COVID-19 pandemic in Vancouver, Canada. RESULTS: Of the 738 individuals included in this analysis, 272 (36.9%) reported that the quality of drugs declined during the COVID-19 pandemic. In multivariable analysis, perceived decline in the quality of drugs was significantly associated with: recent non-fatal overdose (adjusted odds ratio [AOR]=2.01, 95% Confidence Interval [CI]: 1.29-3.15), at least weekly injection drug use (AOR=1.94, 95% CI: 1.40-2.71), at least weekly crack use (AOR=1.61, 95%CI: 1.10-2.36), and at least weekly crystal methamphetamine use (AOR=1.46, 95%CI: 1.03-2.08). DISCUSSION: Over a third of PWUD perceived that the quality of drugs declined during the COVID-19 pandemic and these individuals were significantly more likely to report experiencing a recent non-fatal overdose, engaging in frequent injection drug and stimulant use. Study findings indicate the need for interventions to address the toxic drug supply, including providing a regulated supply.