The Association between Intentional Overdose and Same-Sex Sexual Intercourse in a Cohort of People who Inject Drugs in Melbourne, Australia

ABSTRACT

Background: People who inject drugs (PWID) are at disproportionately high risk of suicidal behaviors, as are individuals who report same-sex attraction or experience. However, there is little evidence of compounded risk of suicide for individuals who report same-sex sexual intercourse (SSI) and are PWID. Objectives: To explore the associations of lifetime intentional overdose amongst a cohort of PWID, with particular attention to those reporting SSI. Methods: The sample included 529 participants, from an ongoing cohort of 757 PWID. An “ever” SSI variable was created for participants who reported sexual intercourse with a same-sex partner at any longitudinal interview. We explored the adjusted associations between SSI and lifetime intentional overdose using logistic regression. Results: Ninety-one (17%) participants reported ever experiencing an intentional overdose. Forty-one (8%) participants reported SSI at any interview. Three hundred and sixty (68%) participants reported diagnosis of a mental health condition. Diagnosis of a mental health condition (AOR = 2.02, 95% CIs: 1.14, 3.59) and SSI (AOR = 2.58, 95% CIs: 1.22, 5.48) significantly increased the odds of lifetime intentional overdose. Conclusions/Importance: We found a heightened risk of intentional overdose amongst PWID reporting SSI, after controlling for diagnosis of a mental health condition. Services need to be aware of this heightened risk and target interventions appropriately.

KEYWORDS:

• People who inject drugs
• lesbian/gay/bisexual
• sexual orientation
• intentional overdose
• suicide

Acknowledgments

The authors wish to thank the participants of the MIX study along with the staff of the community based organizations who assisted with recruitment. Thank you to members of the MIX study team who assisted with participant recruitment, follow up and interviewing.

Declarations

The MIX study was funded by The Colonial Foundation Trust and the National Health and Medical Research Council (NHMRC Grant #545891). DO'K receives support from the NHMRC through a postgraduate scholarship. AB is an NHMRC Early Career Fellow. PD is an NHMRC Senior Research Fellow. The authors gratefully acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program's support of the Burnet Institute. The funding bodies played no role in the study design, data analysis or preparation of the manuscript for publication.

PD has received funding from Gilead Sciences Inc and Reckitt Benckiser for work unrelated to this study. Other authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. The authors confirm that this paper has not been published, or is being considered for publication, elsewhere.