Parenting and childcare responsibilities, harm reduction service engagement, and opioid overdose among women and men who use illicit opioids in New York City.

BACKGROUND

Little is known regarding relationships among parenting, engagement in harm reduction services, and overdose risk among people who use illicit opioids (PWUIO), and whether associations differ by gender.

METHODS

Using baseline data from an ongoing study among PWUIO in New York City ( = 575), we measured childcare factors (i.e., residing with children, avoidance of drug treatment for fear of child welfare, difficulty accessing harm reduction due to childcare issues), and harm reduction services and overdose-related outcomes. Among those with children, we estimated prevalence ratios (PR) using modified Poisson regression with a product-interaction term for gender differences.

RESULTS

In the total sample ( = 575), approximately 70% reported having children. Compared to men, women were more likely to reside with children (25% vs 36%; -value = 0.04), avoid treatment for fear of child welfare (16% vs 26%; -value = 0.04), and less likely to be trained in naloxone administration (68% vs 61%; -value = 0.09). Among participants with children ( = 403), residing with children was associated with naloxone training among men (aPR 1.28, 95% CI: 1.01, 1.62). Avoiding treatment for fear of child welfare was associated with carrying naloxone overall (aPR 0.68, 95% CI: 0.46, 0.99), with a stronger association among women (aPR 0.48, 95% CI: 0.26, 0.92). Difficulty accessing services due to childcare was associated with lifetime overdose (aPR 1.53, 95% CI: 1.05, 2.23).

CONCLUSION

Childcare responsibilities may be a barrier for accessing substance use services and treatment for men and women. Further qualitative and mixed-methods research is needed to understand how to make treatment and services accessible for parents.