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

Context 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.

Objective 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.

Study Design Cross-sectional study using a community-based survey. Data was analyzed using descriptive statistics.

Setting or Dataset Participants were recruited from community organizations in central Edmonton, Canada to participate in interviewer-administered surveys from April to September 2023.

Population Studied 499 structurally vulnerable PWUD, defined as engaging in regular use of currently illegal drugs at least once a month and spending time in Edmonton's inner city.

Intervention/Instrument 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.

Outcome Measures N/A

Results 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.

Conclusions 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.