Patterns of polysubstance use disorder among human trafficking survivors: A latent class analysis.

BACKGROUND: Substance use is commonly documented among human trafficking (HT) survivors in emergency department (ED) settings. Multiple substance use disorders (poly-SUD) are associated with poor health and psychosocial outcomes. This study identified latent classes and demographic covariates of HT-related ED visits by the types of SUDs documented in survivors' medical records. METHODS: We used cross-sectional data from the United States 2019-2021 Nationwide Emergency Department Sample, including visits of patients aged 12-64 years with an ICD-10-CM code documenting either sex or labor exploitation (N = 4,212). A bias-adjusted three-step latent class analysis was conducted, with SUDs documented via ICD-10-CM codes included as indicators in the model. RESULTS: The optimal three-class solution had superior fit based on pre-selected indicators, low classification error, and acceptable entropy. The largest class comprised 76.01 % of the sample and showed a lower predicted probability of the SUD classes considered. The second largest class (17.27 %) was characterized by high predicted probability of stimulant use disorder with moderately high predicted probability of opioid use disorder. The smallest class (6.72 %) was characterized by high predicted probability of each SUD considered. Class membership was differentially associated with disposition from the ED, nicotine use disorder, and income. CONCLUSIONS: Although most ED visits were classified as having relatively low probability of SUD, nearly one quarter of the sample had high risk of either stimulant use disorder or high poly-SUD. Poly-SUD in HT survivors is associated with increased risk of hospitalization. Findings provide direction for tailoring intervention programs to support SUD recovery among HT survivors.