ECPN poster contestant: Opiate Use in Skid Row

Background and Purpose: Los Angeles’ Skid Row has the largest concentration of individuals experiencing homelessness in the United States. With the current opiate epidemic it is important to understand how homeless and residentially instable individuals experience opiate use. A pilot study was conducted to investigate risky behavior amongst those who engage in recreational prescription opioid abuse and heroin use, while exploring the role of a comprehensive harm reduction center on risk taking behavior.

Methods: Using convenience sampling 50 individuals were recruited for focus groups and survey data was collected from 100 individuals receiving services from a harm reduction center located in Skid Row in Los Angeles. Individuals over the age of 18 obtaining services from the agency who reported using prescription opiates in the past year were eligible for participation. The University of Southern California Institutional Review Board approved all data collection methods.

Results: Of the 50 focus group respondents, most were male (74%) and Latino (29%), followed by African American (27%). Most reported a high school education (94%) and the majority were unemployed, disabled or not working (86%). Almost three-fourths reported an income of $9,999 and under (74%) and over half (53%) reported living on the streets. Individuals in the focus groups described their opiate use trajectories, overdose and other health risk behavior outcomes, availability of opiates, current treatment barriers, and the role of the harm reduction center. The 100 survey respondents were primarily male (71%), African American (44%) and experiencing some form of homelessness/residential instability (72%). Almost two-thirds reported an income of $9,999 and less (64%), the majority were unemployed or disabled (84%), and 71% reported a high school degree or above. Using the NIDA-modified ASSIST 30% met the high risk score for prescription opiate use and 45% met the high risk heroin use, and overdose experiences were reported by almost half (46%) of the sample. Associated risks included 27% reporting exchange sex, 64% reporting engaging in sexual activity without a condom while under the influence of opiates, and 41% experiencing some form of victimization associated with their opiate use.

Conclusions and Implications: Individuals experiencing homelessness who use opiates may face increased barriers due to a lack of understanding from service providers, stigma associated with injection drug use, and limited understanding of or access to opiate antagonist medications. Access to comprehensive harm reduction is one strategy to address health disparities for this population.