Increasing Public Health Awareness of the Intersection Between Human Trafficking and the Opioid Epidemic

According to the Trafficking Victims Protection Act of 2000, “sex trafficking is a commercial sex act induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age,”¹ where force, fraud, or coercion does not have to be proved if a third party is involved. In a recent female sex worker study in Baltimore, Maryland, by Footer et al., the age inclusion criteria included that participants be 15 years or older although the authors reported that participants were 18 to 61 years.² This directly indicates that participants may have been victims of sex trafficking if younger than 18 years per the Trafficking Victims Protection Act. However, the authors did not mention the number of participants or those screened for the study who were younger than 18 years.² They did not assess whether participants had third-party involvement, such as a pimp or trafficker, and did not mention human trafficking or assessment of pimp or trafficker abuse. However, other studies have found that 91% of those involved in prostitution have a pimp, with 78% reporting they want to exit prostitution.³

Footer et al. found that 70% of participants engaged in daily heroin use and that 11.6% reported daily opioid pill use. The opioid crisis is a public health epidemic for which structural factors need to be assessed.⁴ A human trafficker can exploit an individual’s opioid addiction to coerce the individual into human trafficking.⁵ An antitrafficking service provider in Maine reported that 66% of clients’ substance abuse led to their being trafficked, whereas only 4.5% reported that their addiction was a result of being trafficked.⁶ Footer et al. did not assess when substance use started relative to being trafficked or whether a third party was facilitating and exploiting their substance abuse. Because human trafficking and opioid addiction are public health issues, there should be a better understanding of their intersection, and a victim-centered and trauma-informed approach to working with these vulnerable populations should be considered.⁷ The authors did mention upstream structural changes that could influence policy and law enforcement efforts to avoid further stigmatizing sex workers and substance users, who may in fact be trafficked.

From an ethical standpoint, there should be screening questions in studies involving commercial sex to ascertain whether any form of human trafficking is occurring, especially when minors are involved. The American Public Health Association has stated that combating human trafficking is a multidisciplinary public health effort.⁷ Because of the intersection of the human trafficking and opioid addiction epidemics, public health professionals should be responding on the frontlines.