U.S.-born citizens are victims of human trafficking typically exploited through sex trafficking. At least some of them interact with healthcare providers during their trafficking experience; yet a majority goes unidentified. Although protocols and training guides exist, healthcare providers often do not have the necessary skills to identify and assist victims of sex trafficking. Understanding where victims seek care and barriers for disclosure are critical components for intervention. Thus, this study interviewed survivors of sex trafficking to ascertain: a) healthcare settings visited during trafficking, b) reasons for seeking care, and c) barriers to disclosing victimization. An exploratory concurrent mixed-methods approach was utilized. Data were collected between 2016–2017 in San Diego, CA and Philadelphia, PA (N = 21). Key findings: 1) Among healthcare settings, emergency departments (76.2%) and community clinics (71.4%) were the most frequently visited; 2) medical care was sought mainly for treatment of STIs (81%); and 3) main barriers inhibiting disclosure of victimization included feeling ashamed (84%) and a lack of inquiry into the trafficking status from healthcare providers (76.9%). Healthcare settings provide an opportunity to identify victims of sex trafficking, but interventions that are trauma-informed and victim-centered are essential. These may include training providers, ensuring privacy, and a compassionate-care approach.

While a range of sources exist for marijuana users to acquire marijuana for medical or personal use, prior research on marijuana sources primarily focused on single sources. In this analysis, we longitudinally examined characteristics of multiple sources selected by marijuana users, motivations to use sources, and how a blend of marijuana sources accommodated users’ needs. Young adult marijuana users (n = 60) in Los Angeles, CA, where marijuana has been legal for medical use since 1996, completed two annual qualitative interviews on marijuana use practices and sources between 2014 and 2016. Approximately two-thirds were medical marijuana patients and one-third was non-patient users. Participants reported acquiring marijuana from the following primary sources across two interviews: dispensaries and delivery services, private sellers in the illicit market, friends and family, and marijuana events/conferences. While patients with legal medical access to marijuana typically purchased marijuana from dispensaries or delivery services, they often supplemented from other illicit sources. Non-patients often accessed marijuana through dispensary diversion but also other sources. As patients became non-patients and vice versa during the study period, source type changed too. Broad access to marijuana via legal and illicit sources in this sample is indicative of societal trends towards normalization of marijuana use.

The experiences of violence and overdose are highly prevalent among women who use illicit drugs. This study sought to ascertain whether multiple victimizations during adulthood increase the frequency of women’s overdose. The sample comprised 218 women recruited at Philadelphia harm reduction sites during 2016–2017. Victimization was assessed as exposure to 16 types of adulthood violence. Three measures were constructed for multiple victimizations: continuous and categorical polyvictimization, and predominant violence domain. Negative binomial regression estimated the incidence rate ratio (IRR) of lifetime overdoses from multiple victimizations. Lifetime history of opioid use (88.6%) and drug injection (79.5%) were common. Among overdose survivors (68.5%), the median of lifetime overdoses was 3. The majority of participants (58.7%) were victims of predominantly sexual violence, 26.1% experienced predominantly physical abuse/assault, and 3.7% were victims of predominantly verbal aggression/coercive control. Participants reported a mean of seven violence types; the higher-score category of polyvictimization (9–16 violence types) comprised 41.7% of the total sample. In multivariable models, one-unit increase in continuous polyvictimization was associated with 4% higher overdose rates (IRR: 1.04, 95% confidence interval [CI]: [1.00, 1.08]). Compared to women who were not victimized (11.5%), those in the higher-score category of polyvictimization (IRR: 2.01; 95% CI: [1.06, 3.80]) and exposed to predominantly sexual violence (IRR: 2.10, 95% CI: [1.13, 3.91]) were expected to have higher overdose rates. Polyvictimization and sexual violence amplified the risk of repeated overdose among drug-involved women. Female overdose survivors need to be screened for exposure to multiple forms of violence, especially sexual violence. Findings underscore the need to scale-up victimization support and overdose prevention services for disenfranchised women.