Sex workers face mortality rates from overdose that dwarf the general population. We're talking about an external-cause mortality risk roughly 8-12 times higher for these marginalized groups. The direct link is undeniable: studies show a significant history of substance dependence (100% in one cohort) with opioids involved in ~90% of those fatal events. It's crucial to note these are likely "conservative estimates" because many records don't capture sex work status.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12405828/
The driving factor isn't the work itself, but the trauma surrounding it. You see a high burden of PTSD, anxiety, and depression that predates or coincides with substance use. For many, the drug use, especially "polysubstance" mixing of opioids and benzos, is a form of self-medication to numb the violence and stigma
https://onlinelibrary.wiley.com/doi/10.1111/acps.13559
The overdose is often a direct consequence of criminalization and policing. Research shows that when police target sex workers or create barriers to safe consumption sites, the odds of a fatal overdose more than double (AOR 2.15)