Co-occurring Issues Facing Patients Who Use Unregulated Drugs: Insights From a Survey in Edmonton, Canada

<h3>Context</h3> The COVID-19 pandemic and ongoing unregulated drug poisoning emergency have dramatically increased morbidity and mortality in major urban centres across the US and Canada. <h3>Objective</h3> The objective of this study was to characterize the substance use patterns of people who use drugs (PWUD), assess the rates of co-occurring conditions and examine the health service needs of this population. <h3>Study Design</h3> Cross-sectional study using a community-based survey. Data was analyzed using descriptive statistics. <h3>Setting or Dataset</h3> Participants were recruited from community organizations in central Edmonton, Canada to participate in interviewer-administered surveys from April to September 2023. <h3>Population Studied</h3> 499 structurally vulnerable PWUD, defined as engaging in regular use of currently illegal drugs at least once a month and spending time in Edmonton9s inner city. <h3>Intervention/Instrument</h3> Survey questions focused on socio-demographic information, substance use patterns, health status, use of treatment and harm reduction services, and acceptability of emerging services. Participants received a CA$30 cash honorarium for their time. <h3>Outcome Measures</h3> N/A <h3>Results</h3> 65% (324/499) of participants identified as men, and the average age was 44. 69% (343/499) of participants identified as Indigenous, and a majority of participants (80%, 401/499) did not currently have housing. 88% (440/499) reported having witnessed a drug poisoning/overdose in the previous 6 months, and 75% (376/499) reported having lost someone they cared about to a drug poisoning. Of those who reported losing someone they cared about, 81% (304/376) said they have lost more people due to poisonings since the start of the COVID-19 pandemic. 76% (379/499) of participants expressed having a diagnosed or undiagnosed serious mental health problem, such as depression, anxiety, post-traumatic stress disorder, bipolar disorder, or schizophrenia. 40% (201/499) of participants were reluctant to seek medical care because they use drugs. <h3>Conclusions</h3> There is a substantial rate of co-occurring houselessness and mental illness among PWUD in central Edmonton. This is compounded by both widespread grief from the loss of loved ones to a highly potent and often contaminated drug supply, and reluctance to seek out medical care. These results point to the importance of using a trauma-informed lens to address co-occurring mental health conditions and structural vulnerability among patients who use drugs.