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. Author manuscript; available in PMC: 2007 Nov 2.
Published in final edited form as: Drug Alcohol Depend. 2007 Jun 11;91(1):50–56. doi: 10.1016/j.drugalcdep.2007.05.003

Income Generating Activities of People Who Inject Drugs

Kora DeBeck 1, Kate Shannon 1, Evan Wood 1,2, Kathy Li 1, Julio Montaner 1,2, Thomas Kerr 1,2
PMCID: PMC2047290  NIHMSID: NIHMS31733  PMID: 17561355

Abstract

Background

Injection drug users (IDU) commonly generate income through prohibited activities, such as drug dealing and sex trade work, which carry significant risk. However, little is known about the IDU who engage in such activities and the role of active drug use in perpetuating this behavior.

Methods

We evaluated factors associated with prohibited income generation among participants enrolled in the Vancouver Injection Drug Users Study (VIDUS) using logistic and linear regression. We also examined which sources of income respondents would eliminate if they did not require money to pay for drugs.

Results

Among 275 IDU, 145 (53%) reported engaging in prohibited income generating activities in the past 30 days. Sex work and drug dealing accounted for the greatest amount of income generated. Non-aboriginal females were the group most likely to report prohibited income generation. Other variables independently associated with prohibited income generation include daily heroin injection (AOR = 2.3) and daily use of crack cocaine (AOR = 3.5). Among these individuals, 68 (47%) indicated they would forgo these earnings if they did not require money for illegal drugs, with those engaged in sex trade work (62%) being most willing to give up their illegal source of income.

Conclusion

These findings suggest that the costs associated with illicit drugs are compelling IDU, particularly those possessing markers of higher intensity addiction, to engage in prohibited income generating activities. These findings also point to an opportunity to explore interventions that relieve the financial pressure of purchasing illegal drugs and reduce engagement in such activities, such as low threshold employment and expansion of prescription and substitution therapies.

Keywords: IDU, Income Generation, Sex Trade Work, Drug Dealing

1. Introduction

Traditionally, society has attempted to discourage psychoactive drug use by employing a range of law enforcement tactics. These approaches have been shown to inflate the price of illegal drugs. The high costs associated with illegal substances may deter and regulate drug use among certain individuals (Benson et at., 2001); however, other drug users may resort to various forms of prohibited activities, including drug dealing, sex trade work and acquisitive crime to generate sufficient income to support their preferred level of drug consumption (Casavant and Collin, 2001; Benson et al., 1992; Brochu et al. 1999; Haynes 1998; Nurco 1987).

Past investigations have established a strong link between drug dependency and prohibited income generating activities (Stevens et al., 2003; Sherman and Latkin, 2002; Fischer et al., 2001; Deschenes and Anglin, 1991; Silverman and Spruill, 1977). High levels of prohibited activity have also been found to coincide with periods of heavy drug consumption (Grapendaal, et al., 1995; Nurco et al., 1985; Ball et al., 1983). Additionally a lack of employable job skills, past criminal histories and high profits derived from drug dealing have been identified as factors influencing substance dependent individuals to engage in prohibited income generating behaviour (Sherman et al., 2006; Rothbard et al., 1999; Bretteville-Jensen and Sutton, 1996; Hammersley et al., 1989).

Prohibited income generating activities have a number of potential negative impacts on individuals and society. In 2002 the Canadian Centre on Substance Abuse found that in Canada over 20% of federal inmates report that they committed their most serious offence in order to obtain illegal drugs (Pernanen et al., 2002). The costs of incarcerating substance addicted individuals for their criminal income generating acts is only one aspect of the negative social impacts of this phenomenon. Theft, fraud and other types of acquisitive crime financially burden society and activities that surround drug dealing have been associated with public nuisances and increased drug consumption by making illegal substances readily available (Bretteville-Jensen and Sutton, 1996). Additionally, confrontations related to the illegal drug market account for the majority of violent interactions involving drug users (Casavant and Collin, 2001; Erickson 2001; Caulkins and Reuter, 1996), making drug dealing a dangerous activity.

Involvement in the sex trade industry is also associated with significant health risks and social costs. In Canada the sale of sexual services between consenting adults is legal; however, provisions regarding bawdy houses, procuring and communicating make many of the acts surrounding sex trade work illegal. In turn sex trade workers operate in an inherently dangerous unsanctioned environment which threatens their health and safety (Goodyear et al., 2005; Blankenship and Koester, 2002).

The relationship between negative health outcomes and activities such as panhandling and salvaging recyclable materials (binning) may appear less direct. However, major urban cities, including the City of Vancouver, Canada, have identified such activities as potential economic threats to urban cores as some citizens report feeling unsafe around individuals engaging in these activities and therefore may avoid affected areas. Similarly, there are concerns that a high prevalence of panhandling and binning threatens the public image of affected cities and thereby has the potential to deter tourism and foreign investment (City of Vancouver, 2006). In a number of major cities in North America (e.g., Toronto, Atlanta, Baltimore, Cincinnati, New Haven, New York City, Philadelphia, Portland, San Francisco, and Seattle) policy makers have introduced legislation to increase the ability of law enforcement to arrest and prosecute individuals for panhandling and engaging in other undesirable behaviour (New York State Law, 2006; Safe Streets Act 1999;).

While previous studies have identified prohibited income generation among injection drug users (IDU) (Sherman and Latkin, 2002), there have been few studies that have assessed the characteristics of IDU who engage in such activities. As well, there have been few studies that have detailed the amount of income derived from various prohibited sources and examined the role of ongoing drug use in perpetuating engagement in different prohibited income generating activities. Therefore, we sought to explore the prevalence of and factors associated with engaging in prohibited income generating activities among a community-recruited cohort of IDU. We also sought to shed light on the relationship between the costs associated with purchasing illegal substances and motivations for engaging in prohibited income generating activity among IDU.

2. Methods

Beginning in May 1996, persons who had injected illegal drugs in the previous month were recruited into the Vancouver Injection Drug User Study (VIDUS), a prospective cohort study that has been described in detail previously (Tyndall et al., 2002; Wood et al., 2001). Briefly, persons were eligible for the VIDUS study if they had injected illegal drugs at least once in the previous month, resided in the greater Vancouver region, and provided written informed consent. At baseline and semi-annually subjects provided blood samples and completed an interviewer-administered questionnaire. Participants receive $20 for each study visit. The questionnaire elicits demographic data as well as information about drug use, income sources, HIV risk behavior and drug treatment. The study has been approved by the University of British Columbia's Research Ethics Board. The present analysis is restricted to those participants who were actively injecting drugs and seen for follow-up during the period June, 2005 to December, 2005. Analysis variables are available only for this sample period.

Respondents were asked to identify all income sources over the past 30 days. Categories of income sources included; social assistance (including disability, pensions and other forms of government transfers), family and friends, paid work (including under the table employment), binning (includes salvaging recyclable materials), sex trade work, drug dealing, criminal activity (category encompasses remaining criminal activity including theft, break and entry, robbery, fraud, etc.,) and panhandling. Respondents were then asked “If you didn't need the money to pay for your drug use, are there any sources of income in the last 30 days that you would eliminate?”. Those who responded ‘yes’ were then asked to indicate the specific income sources they would choose to eliminate.

To assess the prevalence of, and determine factors associated with, participation in prohibited income-generating activities the categories for sex trade work, drug dealing, criminal activity, binning and panhandling were combined into a separate category titled ‘prohibited activities’ which served as a dependent variable of interest for subsequent analyses. However, we also considered a second dependent variable which consisted of only sex trade work, drug dealing and other criminal activity as a means of determining if there were meaningful differences when the less risky activities of binning and panhandling were excluded from the analysis.

Socio-demographic variables of interest considered in analyses included: age (per year older), gender (female versus male), ethnicity (Aboriginal versus non-Aboriginal), and homelessness (defined as having no fixed address for the last six months). Behavioral and drug use variables, based on activities in the last six months, included: frequent heroin injection (consistently injecting once or more per day), frequent cocaine injection (consistently injecting once or more per day), frequent crack use (consistently smoking once or more per day), syringe borrowing (at some time in last six months), syringe lending (at some time in last six months), enrolment in any addiction treatment program (at some time in last six months) and injecting in public spaces (defined as having at some time in the last six month injected on public streets, in alleys, public washrooms, parks and abandoned buildings). All definitions have been used previously (Wood et al., 2001).

For the primary analysis, univariate and multivariate statistics were used to determine factors associated with engaging in any prohibited activity. In univariate analysis categorical explanatory variables were analyzed using Pearson's Chi-square test and continuous variables were analyzed using the Wilcoxon rank sum test. To evaluate factors independently associated with engaging in any prohibited activity, all variables of interest were entered into a fixed multivariate logistic regression model. Using the same independent variables of interest, a separate logistic regression model was constructed to examine factors associated with only the more restricted set of riskier prohibited activities (i.e., sex trade work, drug dealing, and other criminal activities). We also assessed all two-way interactions.

In sub analyses, three separate linear regression models, which included the same independent variables of interest, were constructed to identify factors predicting the amount of income generated through prohibited activities, as well as predictors of the number of days in the last month spent involved in drug dealing and sex trade work respectively. In further sub analyses, we constructed two separate logistic regression models seeking to identify predictors of willingness to give up sex trade work and willingness to give up drug dealing.

3. Results

During the study period, 465 individuals completed follow-up visits and 275 (59%) reported active injection drug use. Of the 275 active injecting participants eligible for this analysis 127 (46%) were women and the median age of participants was 39 (IQR = 30–47). As indicated in Table 1, a total of 145 (53%) study participants reported having generated income through prohibited activities in the last 30 days, while 118 (43%) reported engaging in at least one of the restricted set of riskier prohibited activities (i.e., sex trade work, drug dealing, and other criminal activity). The median number of prohibited activities that participants engaged in was 1 (IQR = 1). The median number of days spent participating in income generating activities (16 days, IQR: 8 - 30) was the same when the broader and more restricted set of prohibited income activities were considered.

Table 1.

Study participants' (n=275) sources of income in the last 30 days.

Income Source N (%) reporting activity Median income* (IQR) Median days engaged in activity (IQR) N (%) would give up activity**
Social Assistance 231 (84) 800 (530-990) - -
Drug Dealing†‡ 74 (27) 1,500 (400-4,500) 17 (10-30) 30 (41)
Sex Trade Work†‡ 50 (18) 1,000 (220-2,200) 10 (5-20) 31 (62)
Paid Work 38 (14) 620 (225-1,350) 6 (4-20) -
Panhandling‡ 25 (9) 500 (110-1,200) 20 (10-30) 10 (40)
Family and Friends 21 (8) 275 (100-600) - -
Binning‡ 19 (7) 200 (70-400) 12 (5-20) 1 (5)
Criminal Activity†‡ 12 (4) 600 (300-1,500) 20 (2-30) 6 (50)
All Prohibited Activities 145 (53) 1,000 (300-3,000) 16 (8-30) 68 (47)
Restricted Prohibited Activities 118 (43) 1,000 (360-4,000) 16 (8-30) 62 (53)
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*

Refers to amount of income generated in the last 30 days in dollars

**

Data recorded only for prohibited activities

‡

Are activities included in the ‘all prohibited activities’ category

†

Are activities included in the ‘restricted prohibited activities’ category

Drug dealing was the most frequently reported prohibited source of income (n=74, 27%) followed by sex trade work (n=50, 18%). Of note, women were more likely than men to report sex trade work [n=47 (37%) vs. n=3 (2%)]. The median monthly income earned through drug dealing was reported to be $1,500 (IQR: 400-4,500) and $1,000 (IQR: 220-2,200) for sex trade work. The category that encompassed all other criminal activity was the least frequently reported source of income among respondents (n= 12, 4%). The majority of our sample (n= 231, 84%) reported income from some form of social assistance in the last 30 days. The median income derived from social assistance was $800 (IQR: 530-990). Other sanctioned income sources generated relatively less income, and only a small proportion of respondents reported earnings through paid work (n= 38, 14%).

As indicated in Table 1, among individuals who reported income from any prohibited activity (n=145), 68 (47%) indicated they would no longer engage in the reported prohibited activities if they did not need money for drugs. Among those who reported income from sex trade work, 31 (62%) indicated they would no longer engage in sex trade work if they did not require money for drugs. Further, 30 (41%) respondents reporting income from drug dealing, 6 (50%) respondents reporting engaging in other criminal behavior, 10 (40%) respondents reporting panhandling and 1 (5%) respondent who reported binning stated that they would eliminate these respective income sources if they did not require money to pay for illegal substances.

The univariate analyses of associations between independent variables of interest and engagement in prohibited income generating activities are shown in Table 2. As indicated, frequent crack use (OR = 4.6, 95% CI: 2.6 – 7.2), syringe lending (OR = 4.2, 95% CI: 1.4 – 12.8), frequent heroin use (OR = 2.7, 95% CI: 1.7 – 4.6), public injecting (OR = 2.7, 95% CI: 1.4 – 5.5), female gender (OR = 2.5, 95% CI: 1.5 - 4.0) and homelessness (OR = 2.5, 95% CI: 1.3 – 5.0) were positively associated with engaging in prohibited income generating activities.

Table 2.

Univariate analyses of study participants' characteristics stratified by those who did and did not report prohibited income sources.

Prohibited* income source
Characteristics Yes
n, (%)		 No
n, (%)		 OR† 95% CI
Median Age (IQR)‡ 36 (16) 41 (13) 1.0 (0.9 – 1.0)
Frequent Crack Use† Yes 99 (70) 43 (30) 4.6 (2.6 – 7.2)
No 46 (35) 87 (65)
Syringe Lending† Yes 17 (81) 4 (19) 4.2 (1.4 – 12.8)
No 128 (50) 126 (50)
Frequent Heroin Use† Yes 75 (68) 36 (32) 2.7 (1.7 – 4.6)
No 70 (43) 94 (57)
Public Injecting† Yes 34 (72) 13 (28) 2.7 (1.4 – 5.5)
No 111 (49) 117 (51)
Gender F 82 (65) 45 (35) 2.5 (1.5 – 4.0)
M 63 (43) 85 (57)
Homelessness† Yes 34 (71) 14 (29) 2.5 (1.3 – 5.0)
No 111 (49) 116 (51)
Syringe Borrowing† Yes 13 (62) 8 (38) 1.5 (0.6 – 3.7)
No 132 (52) 122 (48)
Frequent Cocaine Use† Yes 33 (52) 30 (48) 1.0 (0.6 – 1.7)
No 112 (53) 100 (47)
Addiction Treatment† Yes 76 (50) 76 (50) 0.8 (0.5 – 1.3)
No 69 (56) 54 (44)
Aboriginal Ethnicity Yes 40 (48) 43 (52) 0.8 (0.5 – 1.3)
No 105 (55) 87 (45)
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OR = Odds Ratio; CI = Confidence Interval.

*

Prohibited income categories include; sex trade work, drug dealing, other criminal activity, panhandling, and binning.

‡

Age per year older.

†

Denotes activities or situations referring to previous 6 months.

When examining potential interactions between variables of interest, an interaction effect was identified between gender and ethnicity. This interaction was driven by sex trade being dominated by non-aboriginal females. To account for this, a new class variable was defined to combine gender and ethnicity whereby the reference group was non-aboriginal females. These class variables were included along with all other variables of interest in the multivariate logistic regression models.

When all prohibited activities were considered (see Table 3), the group most strongly associated with reporting prohibited income generation were non-aboriginal females. Frequent crack use (Adjusted Odds Ratio [AOR] = 3.5, CI: 1.9 – 6.2), and frequent heroin injection (AOR = 2.3, CI: 1.3 – 4.1) also remained positively associated with prohibited income generating activities in multivariate analyses. The results remained the same when the dependent variable was restricted to sex trade work, drug dealing, and other criminal activity. Both models are presented in Table 3.

Table 3.

Logistic regression analysis of factors associated with partaking in prohibited income generating activities.

Analysis of all prohibited activities* Analysis of restricted prohibited activities**
Variable AOR 95% CI AOR 95% CI
Age
 (Per year older) 1.0 (1.0 – 1.0) 1.0 (1.0 – 1.0)
Frequent Cocaine Inject†
 (Yes versus No) 0.6 (0.3 – 1.2) 0.7 (0.4 – 1.4)
Frequent Crack Use†
 (Yes versus No) 3.5 (1.9 – 6.2) 3.6 (2.0 – 6.4)
Frequent Heroin Inject†
 (Yes versus No) 2.3 (1.3 – 4.1) 2.6 (1.5 – 4.6)
Syringe Borrowing†
 (Yes versus No) 0.9 (0.3 – 3.0) 0.8 (0.3 – 2.6)
Syringe Lending†
 (Yes versus No) 2.7 (0.8 – 9.8) 2.3 (0.7 – 7.1)
Public Injecting†
 (Yes versus No) 1.4 (0.6 – 3.4) 1.1 (0.5 – 2.5)
Homelessness†
 (Yes versus No) 1.6 (0.7 – 3.8) 1.1 (0.5 – 2.5)
Addiction Treatment†
 (Yes versus No) 0.7 (0.4 – 1.2) 0.8 (0.4. – 1.4)
Non-Aboriginal Female
 (Reference) 1.0 --REF-- 1.0 --REF--
Aboriginal Female
 (Yes versus Reference) 0.3 (0.1 – 0.7) 0.5 (0.2 – 1.0)
Non-Aboriginal Male
 (Yes versus Reference) 0.4 (0.2 – 0.7) 0.4 (0.2 – 0.7)
Aboriginal Male
 (Yes versus Reference) 0.2 (0.1 – 0.7) 0.3 (0.1 – 0.9)
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AOR = Adjusted Odds Ratio; CI = Confidence Interval.

*

All prohibited activities include the following categories= sex trade, drug dealing, other criminal activities, panhandling and binning.

**

Restricted prohibited activities include the following categories =sex trade work, drug dealing, other criminal activities.

†

Denotes activities or situations referring to previous 6 months.

In sub analyses, data representing the amounts of income earned through prohibited activities were converted for use in linear regression models through log transformation to address highly skewed data (range = $40 - $30,000). In the resulting analysis presented in Table 4, frequent heroin injection and frequent crack use where found to be statistically significant predictors of amount of income earned (p < 0.05). Specifically, frequent heroin injectors reported earning 97.4% more income from prohibited sources, and frequent crack users reported earning 197.4% more income from prohibited sources. Other sub analyses attempting to model the predictors of the number of days spend in the last month engaging in drug dealing activities and sex trade work failed to produce significant results, due in part to low event counts. Models seeking to identify predictors of willingness to give up drug dealing and sex trade work also failed to produce significant findings, again due in part to low event counts.

Table 4.

Linear regression of factors associated with income generated from prohibited activities*

Variable Coefficient (β) SE t value p-value
Intercept 6.78 0.78 8.59 < 0.01
Frequent Heroin Injection† 0.68 0.28 2.41 0.02
Frequent Crack Use† 1.09 0.32 3.37 < 0.01
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SE = Standard Error.

*

Prohibited activities include the following categories= sex trade, drug dealing, other criminal activities, panhandling and binning.

†

Denotes activities or situations referring to previous 6 months.

Income data was logged. Model was adjusted for: age, gender, aboriginal ethnicity, frequent cocaine injection, syringe borrowing, syringe lending, public injecting, homelessness, and addiction treatment

4. Discussion

In the present study, we found that 53% of our active IDU sample reported generating income through prohibited activities, with drug dealing and sex trade work found to be the most prevalent sources of income. Factors independently associated with engaging in prohibited income generating activities were frequent crack use and frequent heroin injection. Non-aboriginal females were the group most strongly associated with prohibited income generation; however, it is important to note that aboriginal females were also more likely than males (both aboriginal and non-aboriginal) to report prohibited income generation. This finding should not be interpreted to indicate that aboriginal females are not a high-risk group as previous research has identified an association between aboriginal females and risky drug use practices (Craib et al., 2003). In total, 67 (46%) individuals who reported obtaining income from prohibited sources said they would give up this source of income if they did not need money for drugs, with those who reported earning money through sex trade work being most likely to report that they would eliminate this source of income if they did not require money for drugs.

Consistent with previous studies, a substantial proportion of IDU generate income through prohibited activities (Fischer et al., 1999; Bretteville-Jensen and Sutton, 1996), and those engaging in such activities possess several markers of higher intensity addiction (Sherman and Latkin 2002; Grapendaal et al., 1995). Also consistent with other studies (Bretteville-Jensen and Sutton, 1996; Grapendaal et al., 1995); social security was the most prevalently reported source of income followed by drug dealing and sex trade work, and women were more likely than men to engage in prohibited income generation; a finding largely driven by a much higher proportion of women engaging in sex trade work.

The rates of involvement in sex trade work and drug dealing found in our study are alarming given the previously identified health and social harms associated with these activities, including violence. Furthermore, participation in any of the prohibited activities explored in the current study increases the risk of arrest and incarceration, which has been shown to be a predictor of HIV infection among local IDU (Wood et al., 2005; Small et al., 2005). As indicated by our multivariate analyses, females and those involved in high intensity drug use appear to be most vulnerable to dangers associated with prohibited income generating activities.

A central implication of our findings is that a portion of the prohibited income generation of active IDU, and the harms associated with them, are a function of the costs associated with illegal drugs. By disrupting drug markets and increasing risks involved in producing and distributing illegal substances, prohibition-based drug enforcement policies play a role in inflating drug prices (Reuter and Kleiman, 1986; Caulkins and MacCoun, 2003; Boyum and Kleiman, 2001), which in turn induces active IDU with high intensity addictions to engage in prohibited income generating behavior to finance their drug use. While the ultimate objective of inducing high drug prices is to deter drug use (Caulkins and Reuter, 1996; Office of National Drug Control Strategy 2006), this analysis and a growing body of research indicates that the unintended consequences of these enforcement-based policies produce significant harm for drug using individuals and broader society (Small et al., 2006; Cooper et al., 2005; Kerr et al., 2005; Wood et al., 2004; Aitken et al., 2002; Blankenship and Koester, 2002; Maher and Dixon, 1999). It is important that policy makers recognize these realities and balance the perceived benefits of criminal-prohibition with other associated outcomes, such as increased levels of crime and IDU engagement in risky prohibited income generating activities

While this analysis suggests that higher intensity addiction and the costs associated with purchasing illegal drugs are central factors influencing active IDU to engage in prohibited income generating activities, the lack of available alternative income sources is also an important aspect of this relationship. Many active IDU have difficulty finding sufficient legitimate paid work due in part to unstable housing, limited employable skills and low levels of education (Sherman et al., 2006). One alternative for these individuals is to obtain income assistance and other forms of social assistance; however, income analysis in the present study found the median income from social assistance to be $800, which for most IDU is insufficient to support a secure living and habitual drug consumption (Casavant and Collin, 2001; Fischer et al., 1999). Furthermore, the current structure of social assistance in Canada is such that recipients will lose their income benefits if they begin to earn above $400 per month through legitimate work, leaving this population with limited income generating options beyond resorting to prohibited sources.

Given the association between amount of prohibited income generated and high intensity addiction, the findings of the present study highlight the importance of introducing targeted interventions which focus on individuals with higher intensity addictions. One method of trying to reduce engagement in prohibited income generation among drug user populations with severe addictions is to expand their economic opportunities. This would involve supporting the development of legitimate means of earning income through various low threshold employment opportunities and skill building measures. A recent intervention designed to economically empower drug addicted sex trade workers to develop alternative legitimate sources of income has been shown to have a positive influence on reducing involvement in the sex trade industry (Sherman et al., 2006). Alternatively, policy makers could intervene by providing addiction prescription and substitution therapies to individuals with markers of serious addiction to decrease their reliance on, and subsequent need to purchase, street drugs. This could be achieved in part through heroin prescription programs and by expanding substitution therapies including methadone maintenance. However, given the high prevalence of stimulant use both locally and globally (World Drug Report 2006; Adlaf et al., 2005; Buxton 2005), opiate substitution therapies will have a limited impact, and therefore continued exploration of stimulant replacement therapies is desirable. These types of interventions would both reduce criminal activity and remove profits from criminal organizations.

There are several limitations in this study to be noted. First, as with most other cohort studies of IDU, the VIDUS study is not a random sample, and therefore these findings may not generalize to other IDU populations. Secondly, this study relied on self-reported information concerning sources and amounts of income, as well as predictions of future behavior in theoretical situations and is hence susceptible to recall bias as well as socially desirable reporting. In the present study this may have led to an under-reporting of income derived through criminal activities. Thirdly, reported income sources do not account for ‘in-kind’ transactions. A likely result is that the true monetary profits in the drug dealing category are under reported as many individuals purchase large quantities of drugs to offset the cost of their own consumption or are paid in drugs rather than money for drug dealing work (Bretteville-Jensen and Sutton, 1996). Similarly, sex for drugs exchanges are also not considered in this analysis. As the benefits from these informal exchanges are not reported as income our analysis likely underestimates the extent to which the costs associated with purchasing drugs encourage drug dealing and sex work to support illegal substance use.

In sum, our study suggests that the high costs associated with illegal drugs are particularly problematic for females (largely driven by the high proportion of female involvement in sex trade work) and those possessing markers of high intensity addiction, and these costs likely serve to encourage and perpetuate engagement in illegal income generating activities. Collectively these findings indicate an opportunity to explore the benefits of developing low threshold employment opportunities and prescription and substitution therapies.

Footnotes

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