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Indigenous Harm Reduction Principles and Practices

Most people with substance use problems report having experienced some form of trauma, and most have experienced multiple traumas.18 People often report they use substances to help “cope” with the stress or “numb” negative emotions that result from trauma. Research is continuing to demonstrate that men, women, trans and gender diverse people often have different experiences of trauma and this affects their opioid use. For example: • Compared to other types of substance use, women and men who are addicted to prescription opioids are more likely to report a traumatic event.9 They also tend to have first experienced trauma at a younger age and are more likely to report a childhood trauma, including: childhood abuse or neglect, or having witnessed violence.9 Depression, anxiety, self-harm and suicide are also common among women and men with opioid use disorder (including prescription opioid misuse and illegal opioid use).7,8 • Women and men who are addicted to opioids report different experiences. Among women, the greatest risk for opioid addiction is receiving a prescription for opioid medication.19 Women tend to report experiencing more chronic physical pain, and are more likely to receive a prescription for an opioid painkiller.20,21 The risk for chronic physical pain is even greater among women who have been victims of violence and abuse.22 In contrast, men are more likely to use illegal sources of opioids, and engage in riskier drug-use including: using alone, increasing the amount used, and ingesting in a way other than intended.23-26 • Transgender populations experience very high rates of gender-based discrimination, harassment and physical and sexual violence. Almost all (98%) transgender people in a US study reported one or more traumatic event in their lifetime, compared with 56% of cisgender women and men from the general population.27 While research on opioid misuse among transgender people is limited, the prevalence of non-medical prescription opioid use among transgender adults is high.28 Higher rates of non-medical prescription pain medication use have also been reported among transgender youth, compared to cisgender youth.