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The Center for Health Affairs Hosts Education About the Intersection Between Human Trafficking and Substance Use Disorders

At its August meeting, the Northeast Ohio Hospital Opioid Consortium welcomed representatives from The MetroHealth System to share insights on the intersection between human trafficking and substance use disorders (SUD) as well as ways to identify victims and intervene.

Recognizing the Intersections of Human Trafficking and SUD

Human trafficking is defined as the recruitment, harboring, transportation, or provision/obtaining of a person for sex or labor through either force, fraud or coercion. The barriers for identifying and reporting have allowed victims to go unnoticed even in a hospital or treatment setting. In the state of Ohio — one of the leading states for human trafficking — while healthcare workers are required to report suspected sexual assault for minors, there is no such legal requirement to report suspected human trafficking. In the case of adult trafficking victims, their consent is required before a healthcare worker can contact the police.

Kristin Hess, BSN, RN, CARN, CCHP Clinical Education Specialist for the Office of Opioid Safety at MetroHealth Medical Center, and Anna Becks, BSN, RN, SANE Coordinator for The MetroHealth System, explained the connection between the opioid epidemic and human trafficking through the use of coercion, manipulation and exploitation.

• Coercion – Victims with SUD can be targeted, substances can be introduced, and trafficker can use stigma to convince victims they will not be believed or helped.
• Exploitation – The trafficker will create a dependence on drugs and essentially force a debt on the victim that will never be paid off. The victims will often assume the criminal risk while the trafficker avoids law enforcement repercussions.
• Manipulation – Physiological dependence, relapse and recovery cycles can be used to control victims through withholding drugs, forced withdrawal, threats to report victims to law enforcement or immigration, and even using naloxone as a form of punishment.

Victims are often not recognized by providers due to barriers that prevent identification, such as a lack of knowledge about substance use, implicit bias, siloed treatment (for example, an addiction counselor not asking about historical or current trauma), and a lack of knowledge about services available. Victims also face their own personal barriers to freedom: fear of judgment, prior experience of being discounted due to their substance use, fear of being involuntarily institutionalized, loss of parenting time, and a lack of resources to access services such as transportation, childcare or health insurance.

How to Advocate for Victims of Human Trafficking

Providing training to staff will help them to recognize red flags and give them tools and techniques to intervene. Because the victim’s consent is required in order to contact law enforcement and victims can be reluctant or skeptical to accept help due to the manipulation they experience from traffickers, building trust and rapport is a crucial part of any attempt to intervene. It’s also important to educate staff in trauma-informed care, and dismantle the stigma associated with SUD that can create barriers to identifying and treating victims.

Becks detailed the importance of a trauma-informed approach to communicating with a victim, and shared five important practices:

• Express empathy through reflective listening.
• Avoid direct confrontation.
• Identify any variations between the client’s goals, values and current behaviors.
• Adjust to victim resistance, rather than opposing it.
• Support self-efficacy and optimism.

These tips and more details on how to identify and advocate for victims of human trafficking can be found in the full Opioid Consortium presentation on The Center for Health Affairs’ YouTube Channel.

Please contact Anna Becks at abecks@metrohealth.org and Kristin Hess at khess@metrohealth.org if you’re interested in hosting your own training or if you have any questions.