Substance Use
Gender-based differences in harm reduction practices among people who use drugs in Rhode Island: A latent class analysis Leah Shaw* Leah Shaw Anusha Kumar Carolyn Park Yu Li Catherine Lenox Alexandra Collins Susan Sherman Brandon Marshall Alexandria Macmadu
Background: Previous research has documented differing drug use patterns and risk behaviors by gender identity and sex assigned at birth, but differences in harm reduction practices remain underexplored.
Methods: We utilized data from the Rhode Island Prescription and Illicit Drug Study (RAPIDS), which enrolled adults who used drugs (2020-2023). Participants were analyzed based on gender identity: men, women, and other (including those identifying as non-binary or something else). Participants reported typical harm reduction practices (e.g., use fentanyl test strips, keep naloxone nearby) to avoid accidental overdose. Latent class analysis (LCA) identified harm reduction practice typologies and a correlation matrix examined pairwise relationships between practices.
Results: Among 503 eligible participants, 64% were men, 34% were women, and 2% were non-binary or something else (n=9). Harm reduction practices were comparable between men and women, although men were less likely to keep naloxone nearby (p=0.02). Group membership in latent classes (no/low, moderate, and high utilization of harm reduction practice typologies) did not vary by gender identity. However, those belonging to the no/low utilization subgroup were significantly more likely to have ever been incarcerated (p=0.03) and to be single (p<0.01). Those belonging to the high utilization group were significantly more likely to have ever witnessed an overdose, performed rescue breathing, and administered naloxone (all p<0.001). Correlations showed pairwise relationships, with ‘use fentanyl test strips’ and ‘keeping naloxone nearby’ being positively and significantly correlated (r=0.33, p<0.05).
Conclusions: We found that engagement in harm reduction practices were largely comparable between men and women; however, men who use drugs are significantly less likely to keep naloxone nearby. Gender-attentive strategies to increase naloxone carriage and usage among men may be warranted to mitigate overdose risk.