Prevalence of Substance Use Disorder in Emergency Department Visits Involving Survivors of Human Trafficking

Background and Purpose: Substance use disorder (SUD) is often cited as a substantial challenge for human trafficking (HT) survivors and is associated with poorer health and social outcomes and increased risk of mortality. However, epidemiologic data on SUD in the context of HT is lacking due to the hidden nature of this population. Lack of reliable prevalence data impacts prevention and intervention efforts. Surveillance of HT-related ED visits may be particularly useful to aid in the development of hospital-based programs to promote SUD recovery, as SUD-related ED visits are associated with higher cost of care and increased risk of hospitalization.

Methods: For this cross-sectional study, we used data from the 2019-2020 Nationwide Emergency Department Sample (NEDS), including visits for patients aged 12-64 years with any International Classification of Diseases, Clinical Modification (ICD-10-CM) codes documenting HT as a cause of morbidity (N=1055, SE=88) or a history of HT (N=1596, SE=151). We estimated the prevalence of HT-related visits with SUD, associations between SUD and trafficking type, and demographic variation by SUD. Estimates were weighted to account for the NEDS complex sampling design.

Results: SUD was frequently documented among patients with HT as a cause of morbidity (38.69%, 95%CI:31.71,46.16) and for patients with any history of HT (44.87%, 95%CI:38.77, 51.13). SUD was more frequently documented in sex trafficking (44.48%, 95%CI:36.27,53.00) relative to labor trafficking (18.68%, 95%CI:10.03,32.13). Polysubstance use was documented in 15.00% (95%CI: 10.58, 20.82) of the HT morbidity visits and 21.61% (95%CI: 17.26, 26.70) of the HT history visits. Illicit SUDs were found in approximately 30% of visits, cannabis use disorder in approximately 20% of visits, and alcohol use disorder in approximately 9% of visits. SUD-related ED visits often resulted in hospitalization for both those with HT as a cause of morbidity and for those with a history of HT. Among visits where HT was a cause of morbidity, SUD-related visits (50.23%, 95%CI: 38.28-62.15) had higher rates of hospitalization compared to those with no SUD (12.19%, 95%CI: 7.61-18.97, p<0.001). For those with a history of HT, 75.19% (95%CI: 66.36, 82.32) of SUD-related visits and 46.82% (95%CI: 36.00, 57.95) of non-SUD-related visits resulted in hospitalization.

Conclusions and implications. Among ED visits involving survivors of HT, SUD prevalence in is high, particularly among survivors of sex trafficking. Victims of HT present with a variety of use disorders, and visits with SUD have higher rates of hospitalization. Although the cross-sectional data do not allow us to assess the development of SUD in the context of HT, findings highlight the possible role that hospital-based intervention programs can play in supporting the substance use recoveries of people with HT.