Self-Perceived Health among Canadian Opiate Users: A Comparison to the General Population and to Other Chronic Disease Populations
Millson, Peggy E., Challacombe, Laurel, Villeneuve, Paul J., Fischer, Benedikt, et al., Canadian Journal of Public Health
Background: There are an estimated 40,000 to 90,000 injection opiate users in Canada. The social, economic and health consequences of opiate addiction have been well documented. However, there are no data on the self-perceived health status of opiate users in Canada. Therefore, the goal of this research is to gain an understanding of the self-perceived health status of opiate users by comparing the health-related quality of life of opiate users to chronic disease populations and to the general population.
Methods: The SF-36 was administered to a nonrandom sample of 143 opiate users entering low-threshold methadone treatment. Two sample t-tests were performed to assess statistical differences, at a 5% level of significance, between population scores across SF-36 dimensions.
Results: Opiate users perceived both their mental and physical health as worse than the general population and individuals with minor and serious medical problems, but comparable to those with diagnosed psychiatric illnesses.
Conclusions: Methadone treatment services should incorporate both primary care and psychiatric care into their programs, or at the very least secure appropriate referral mechanisms to ancillary services to ensure that the health concerns of opiate users are dealt with in the context of their treatment program.
There are an estimated 40,000 to 90,000 injection opiate users in Canada.1 In 1992, the use of illicit substances was estimated to cost $18.45 billion in both direct and indirect costs.2 Illicit drug use is associated with morbidity and mortality attributable to the practice of needle sharing leading to infection with HIV, HCV and/or HBV. Injection with poorly sterilized injection equipment or through poorly cleaned skin can also lead to a range of bacterial infections from cellulitis, thrombophlebitis and skin abscesses to septicemia and bacterial endocarditis.3 Drug users also have an increased prevalence of nutritional problems which can lead to susceptibility to infectious diseases such as tuberculosis.3 Strong associations between drug use and mental health problems have been documented with the most common diagnoses being depression, anxiety and antisocial personality.3 The use of illicit drugs is also frequently associated with a complex constellation of correlates of poor health that include: poly-substance use, childhood abuse history, poverty, homelessness, incarceration, violence, difficulty maintaining supportive interpersonal relationships and limited job skills.1,3-5
The myriad of social, economic and health consequences of opiate addiction likely contribute to poorer health among illicit opiate users. However, only two studies have directly evaluated how opiate users perceive their own health and how drug use impacts on their health-related quality of life (HRQOL) prior to treatment entry.6,7 These studies were conducted in Australia and the United States, making generalizability to a Canadian opiate-using population problematic due to differing social and legal climates and because of the potential differing availability of specific drugs and of drug treatment options.
HRQOL "is a construct that reflects a persons' [sic] appraisals of their circumstances in relation to their expectations of life experiences."8 It encompasses physical and mental aspects of quality of life (QoL) that have been shown to affect health.9 It is increasingly being used in public health and clinical research as a complement to other health status indicators and/or outcome indicators in order to capture features of disability and dysfunction associated with chronic illness.8
The objective of these analyses is to assess how opiate users rank in terms of self-perceived health status by comparing the self-perceived health of Canadian opiate users to published values for the general U.S. population and to other chronic disease populations. This will serve to highlight the physical and mental health concerns of opiate users and provide insights for strategies to address these concerns at entry into methadone programs. …