Gallant Kat, Hayashi Kanna, Sayre Eric C, Choi JinCheol, Mansoor Manal, Kerr Thomas
British Columbia Centre On Substance Use, Vancouver, BC, Canada.
Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada.
Subst Abuse Treat Prev Policy. 2025 Feb 22;20(1):9. doi: 10.1186/s13011-025-00637-x.
Canada continues to experience an epidemic of toxic drug-related overdose deaths. Public health messaging emphasizes the dangers of using drugs alone as it restricts timely overdose response or renders it impossible, yet this practice remains prevalent among people who use drugs. While drug use practices and associated harms are known to be highly gendered, little is known about how factors shaping solitary drug use may differ across genders (including cisgender men, cisgender women, transgender women, Two-Spirit people and gender diverse people). Thus, we sought to explore solitary drug use practices according to gender in Vancouver, Canada.
Data were collected through Vancouver Injection Drug Users Study, a prospective cohort study between June 2019 and May 2023. We used gender-stratified multivariable generalized estimating equation models to identify factors associated with using drugs alone.
Among the 697 participants, 297 (42.6%) reported using drugs alone in the previous 6 months at baseline. In multivariable analyses, we found that being in a relationship was negatively associated with using alone for both cisgender men and cisgender women (adjusted odds ratio [AOR] = 0.25 and 0.34, respectively), while homelessness was negatively associated for cisgender men only (AOR = 0.45). Factors positively associated for cisgender men included daily illicit stimulant use (AOR = 1.90), and binge drug use (AOR = 2.18). For cisgender women, only depression was positively associated with using drugs alone (AOR = 2.16). All p-values < 0.05. While unable to conduct a multivariable analysis on transgender, Two-Spirit and gender diverse people due to small sample sizes, bivariate analyses showed larger impact of depression on using alone for Two-Spirit (OR = 8.00) and gender diverse people (OR = 5.05) compared to others, and only gender diverse people's risk was impacted by experiences of violence (OR = 9.63). All p-values < 0.05.
The findings of this study suggest significant heterogeneity in gender-specific factors associated with using drugs alone. Factors exclusively impacting cisgender men's risk included homelessness and daily stimulant use, and depression having a significant impact on cisgender women's, but not cisgender men's, risk. Ultimately, gender-specific factors must be recognized in public health messaging, and in developing policies and harm reduction measures to address the risks associated with using alone.
加拿大持续面临与有毒药物相关的过量用药死亡流行问题。公共卫生宣传强调独自使用毒品的危险性，因为这会限制及时的过量用药应对措施或使其无法实施，但这种做法在吸毒人群中仍然普遍存在。虽然已知吸毒行为及其相关危害存在高度性别差异，但对于影响独自吸毒的因素在不同性别（包括顺性别男性、顺性别女性、跨性别女性、双性人以及性别多元者）之间可能存在怎样的差异却知之甚少。因此，我们试图在加拿大温哥华按性别探索独自吸毒行为。
数据通过温哥华注射吸毒者研究收集，这是一项在2019年6月至2023年5月期间进行的前瞻性队列研究。我们使用按性别分层的多变量广义估计方程模型来确定与独自吸毒相关的因素。
在697名参与者中，297人（42.6%）在基线时报告在过去6个月内有独自吸毒行为。在多变量分析中，我们发现处于恋爱关系中与顺性别男性和顺性别女性独自吸毒均呈负相关（调整后的优势比[AOR]分别为0.25和0.34），而无家可归仅与顺性别男性独自吸毒呈负相关（AOR = 0.45）。与顺性别男性独自吸毒呈正相关的因素包括每日使用非法兴奋剂（AOR = 1.90）和暴饮暴食式吸毒（AOR = 2.18）。对于顺性别女性，只有抑郁与独自吸毒呈正相关（AOR = 2.16）。所有p值均<0.05。由于样本量小，无法对跨性别、双性人和性别多元者进行多变量分析，但双变量分析显示，与其他人相比，抑郁对双性人（OR = 8.00）和性别多元者（OR = 5.05）独自吸毒的影响更大，且只有性别多元者的风险受暴力经历影响（OR = 9.63）。所有p值均<0.05。
本研究结果表明，与独自吸毒相关的性别特异性因素存在显著异质性。仅影响顺性别男性风险的因素包括无家可归和每日使用兴奋剂，而抑郁对顺性别女性的风险有显著影响，但对顺性别男性没有。最终，在公共卫生宣传以及制定政策和减少危害措施以应对独自吸毒相关风险时，必须认识到性别特异性因素。
