Background: Antecedent childhood trauma is common among people who use drugs (PWUD), but its links to overdose are not fully understood. This study aims to examine the longitudinal relationships between childhood trauma and non-fatal overdose among PWUD in Vancouver, Canada.
Methods: We used harmonized data from three community-recruited cohorts of PWUD at the highest risk of overdose death who completed biannual structured interviews. Antecedent childhood trauma was assessed at baseline by the Childhood Trauma Questionnaire (CTQ). Generalized linear mixed-effects models estimated the prospective effects of antecedent childhood trauma on experiencing a recent non-fatal overdose among all participants and stratified by gender.
Results: We included 3,017 participants who contributed a median of 6.4 (Q1-Q3: 1.6-12.5) years of follow-up. They were aged 45.6 (Q1-Q3: 35.4-53.4) years, and 1,980 (65.6%) reported male gender. Of these, 2,189 (72.6%) experienced at least one form of childhood trauma; during follow-up, 1440 (47.7%) ever reported a non-fatal overdose. In unadjusted analyses for men and women, emotional abuse (Odds Ratio [OR]=1.46, 95% confidence interval [CI]: 1.26–1.69; OR=1.36, 95%CI: 1.11–1.67, respectively), physical abuse (OR=1.30, 95%CI: 1.12–1.51; OR=1.23, 95%CI: 1.01–1.50, respectively), and sexual abuse (OR=1.20, 95%CI: 1.00–1.42; OR=1.22, 95%CI: 1.00–1.49, respectively) were associated with non-fatal overdose.
Conclusion: We observed positive associations between antecedent emotional, physical, and sexual abuse and non-fatal drug overdose for both men and women. The high prevalence of childhood abuse and the positive longitudinal links to non-fatal overdose observed in these preliminary analyses support trauma-informed approaches to prevent overdose among PWUD.