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Douglass AR, Maister A, Moeller KE, Salwan A, Vallabh A, Waters K, Payne GH. Exploring the harm reduction paradigm: the role of Board-Certified Psychiatric Pharmacists. Ment Health Clin 2024; 14:253-266. [PMID: 39104432 PMCID: PMC11298032 DOI: 10.9740/mhc.2024.08.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/07/2024] [Indexed: 08/07/2024] Open
Abstract
Deaths related to opioid overdoses continue to climb, and there remains a need for innovative strategies to address this ongoing crisis. Harm reduction (HR), a nonjudgmental philosophy aimed at reducing consequences associated with drug use and other potentially unsafe behavior, has emerged as a compassionate and effective approach. Harm reduction further emphasizes overdose prevention and fosters a shift in perspective that recognizes substance use disorder as a disease and not a moral failing. The tenets of HR collectively advocate for the well-being of individuals who use substances and support any positive change as defined by the individual. Given the high rate of morbidity and mortality associated with substance misuse and barriers or ambivalence to receiving treatment, awareness of and advocacy for HR practice is essential. This manuscript aims to describe evidence-based HR interventions, provide a foundation for the implementation of services, and further promote the importance of providing humanistic care without judgment. As valued members of the multidisciplinary treatment team, Board-Certified Psychiatric Pharmacists should implement and engage in HR services in the settings where people with substance use disorders receive care.
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Affiliation(s)
- Amber R. Douglass
- (Corresponding author) Clinical Pharmacist Practitioner - Mental Health, VISN 1 Clinical Resource Hub - VA Connecticut Healthcare System, West Haven, Connecticut,
| | - Ashley Maister
- Clinical Pharmacist Practitioner - Mental Health, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | | | - Aaron Salwan
- Clinical Pharmacy Specialist, Behavioral Health, Montefiore Nyack Hospital, Nyack, New York
| | - Anuja Vallabh
- SUD/MH Clinical Pharmacist Practitioner, VISN 12 Clinical Resource Hub - Jesse Brown VA Medical Center, Chicago, Illinois
| | - Kristin Waters
- Assistant Clinical Professor, University of Connecticut, Storrs, Connecticut
| | - Gregory H. Payne
- Director of Strategic Initiatives, American Association of Psychiatric Pharmacists, Lincoln, Nebraska
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López-Castro T, Sohler N, Riback L, Bravo G, Ohlendorf E, Ghiroli M, Fox AD. Posttraumatic stress disorder in people who use drugs: syringe services program utilization, treatment need, and preferences for onsite mental health care. Harm Reduct J 2024; 21:108. [PMID: 38824597 PMCID: PMC11143655 DOI: 10.1186/s12954-024-01019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/09/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Syringe services programs (SSPs) are critical healthcare access points for people with opioid use disorder (OUD) who face treatment utilization barriers. Co-locating care for common psychiatric comorbidities, like posttraumatic stress disorder (PTSD), at SSPs may reduce harms and enhance the health of individuals with OUD. To guide the development of onsite psychiatric care at SSPs, we collected quantitative survey data on the prevalence of PTSD, drug use patterns, treatment experiences associated with a probable PTSD diagnosis, and attitudes regarding onsite PTSD care in a convenience sample of registered SSP clients in New York City. METHODS Study participants were administered the PTSD Checklist for the DSM-5 (PCL-5) and asked about sociodemographic characteristics, current drug use, OUD and PTSD treatment histories, and desire for future SSP services using a structured interview. Probable PTSD diagnosis was defined as a PCL-5 score ≥ 31. RESULTS Of the 139 participants surveyed, 138 experienced at least one potentially traumatic event and were included in the present analysis. The sample was primarily male (n = 108, 78.3%), of Hispanic or Latinx ethnicity (n = 76, 55.1%), and middle-aged (M = 45.0 years, SD = 10.6). The mean PCL-5 score was 35.2 (SD = 21.0) and 79 participants (57.2%) had a probable PTSD diagnosis. We documented frequent SSP utilization, significant unmet PTSD treatment need, and high interest in onsite PTSD treatment. CONCLUSIONS Study findings point to the ubiquity of PTSD in people with OUD who visit SSPs, large gaps in PTSD care, and the potential for harm reduction settings like SSPs to reach people underserved by the healthcare system who have co-occurring OUD and PTSD.
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Affiliation(s)
- Teresa López-Castro
- Department of Psychology, The City College of New York, City University of New York, 160 Convent Avenue, New York, NY, 10031, USA.
| | - Nancy Sohler
- The City University of New York School of Medicine, 160 Convent Avenue, New York, NY, 10031, USA
| | - Lindsey Riback
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Gina Bravo
- Department of Psychology, The City College of New York, City University of New York, 160 Convent Avenue, New York, NY, 10031, USA
| | - Eric Ohlendorf
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Megan Ghiroli
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Aaron D Fox
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
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Levenson J, Textor L, Bluthenthal R, Darby A, Wahbi R, Clayton-Johnson MA. Abolition and harm reduction in the struggle for "Care, Not Cages". THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104163. [PMID: 37722347 DOI: 10.1016/j.drugpo.2023.104163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 09/20/2023]
Abstract
Care that is organized around the principles of harm reduction and the movement for police and prison abolition has the potential to uproot and transform structural causes of harm and violence, in the interconnected crises of drug-related harm, policing, and punishment. The United States' crisis of overdose and drug-related harm and its system of policing and punishment are historically and empirically linked phenomena. The abandonment of people whose use of drugs leads to their premature death, in the form of an overdose, is directly and indirectly connected to wider systems of criminalization and incarceration that also produce premature suffering and death. Organizations advocating for harm reduction for people who use drugs (PWUD) and organizations seeking the abolition of police and prisons have developed in parallel albeit with different genealogies. We examine the historical origins, principles, and practical applications of the two movements to identify points of overlap and lessons to be learned for the public health goals of addressing and preventing premature suffering and death in the United States. A case study of Los Angeles (LA) County, where elected officials have promised a new paradigm of care, not punishment, frames our analysis. We show how the principles and strategies of harm reduction and abolition are both necessary to practically realizing a paradigm of care, not punishment, and achieving system transformation.
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Affiliation(s)
- Jeremy Levenson
- Department of Psychiatry, Yale University, United States; Department of Anthropology, UCLA, United States; Center for Social Medicine, University of California Los Angeles, United States
| | - Lauren Textor
- Department of Anthropology, UCLA, United States; Center for Social Medicine, University of California Los Angeles, United States; Department of Psychiatry, UCLA, United States.
| | - Ricky Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine, USC, United States
| | - Anna Darby
- Emergency Medicine Program, LAC+USC Medical Center, Keck School of Medicine at USC, United States
| | - Rafik Wahbi
- Department of Community Health Sciences, UCLA Fielding School of Public Health, United States; Frontline Wellness Network, Los Angeles, United States
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Jakubowski A, Fowler S, Fox AD. Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature. Addict Sci Clin Pract 2023; 18:40. [PMID: 37301953 PMCID: PMC10256972 DOI: 10.1186/s13722-023-00394-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Syringe services programs (SSPs) provide a spectrum of health services to people who use drugs, with many providing referral and linkage to substance use disorder (SUD) treatment, and some offering co-located treatment with medications for opioid use disorder (MOUD). The objective of this study was to review the evidence for SSPs as an entry point for SUD treatment with particular attention to co-located (onsite) MOUD. METHODS We performed a scoping review of the literature on SUD treatment for SSP participants. Our initial query in PubMed led to title and abstract screening of 3587 articles, followed by full text review of 173, leading to a final total of 51 relevant articles. Most articles fell into four categories: (1) description of SSP participants' SUD treatment utilization; (2) interventions to link SSP participants to SUD treatment; (3) post-linkage SUD treatment outcomes; (4) onsite MOUD at SSPs. RESULTS SSP participation is associated with entering SUD treatment. Barriers to treatment entry for SSP participants include: use of stimulants, lack of health insurance, residing far from treatment programs, lack of available appointments, and work or childcare responsibilities. A small number of clinical trials demonstrate that two interventions (motivational enhancement therapy with financial incentives and strength-based case management) are effective for linking SSP participants to MOUD or any SUD treatment. SSP participants who initiate MOUD reduce their substance use, risk behaviors, and have moderate retention in treatment. An increasing number of SSPs across the United States offer onsite buprenorphine treatment, and a number of single-site studies demonstrate that patients who initiate buprenorphine treatment at SSPs reduce opioid use, risk behaviors, and have similar retention in treatment to patients in office-based treatment programs. CONCLUSIONS SSPs can successfully refer participants to SUD treatment and deliver onsite buprenorphine treatment. Future studies should explore strategies to optimize the implementation of onsite buprenorphine. Because linkage rates were suboptimal for methadone, offering onsite methadone treatment at SSPs may be an appealing solution, but would require changes in federal regulations. In tandem with continuing to develop onsite treatment capacity, funding should support evidence-based linkage interventions and increasing accessibility, availability, affordability and acceptability of SUD treatment programs.
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Affiliation(s)
- Andrea Jakubowski
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY 10467 USA
| | - Sabrina Fowler
- Present Address: Ascension St. John Hospital, 22101 Moross Road, Detroit, MI 48236 USA
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Aaron D. Fox
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY 10467 USA
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Paquette CE, Reese ED, Yi JY, Maccarone JM, Stewart ZJ, Daughters SB. Group behavioral activation with and without a smartphone app in intensive outpatient treatment for substance use disorder: A three-arm randomized controlled trial. Drug Alcohol Depend 2023; 243:109758. [PMID: 36634574 PMCID: PMC10026710 DOI: 10.1016/j.drugalcdep.2022.109758] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Reward deficits negatively impact recovery from substance use disorder (SUD). LETS ACT, a behavioral activation treatment targeting substance-free reward, has demonstrated effectiveness in reducing post treatment substance use. There remains room for modifications to extend recovery gains, and LETS ACT remains largely untested in outpatient treatment. We tested the effect of LETS ACT when delivered alongside intensive outpatient SUD treatment, with and without a smartphone app designed to extend access to treatment content outside of clinician-administered sessions. METHODS In this three-arm randomized controlled trial (N = 206; 54 % White, 67 % male), all participants received intensive outpatient SUD treatment as usual (TAU) and either LETS ACT (n = 56), smartphone-enhanced LETS ACT (n = 65), or assessments only (n = 61). Substance use days and substance related problems were assessed through 12 months posttreatment. RESULTS Generalized estimating equations indicated a significant condition*time interaction for substance use days; Days of substance use significantly declined from pretreatment until 1-month for TAU, 3-months for LETS ACT-SE, and 6-months for LETS ACT. Decreases in substance-related problems were maintained across all conditions through 12 months. CONCLUSIONS Adding LETS ACT to intensive outpatient treatment resulted in significant decreases in substance use through 6 months posttreatment, yet these gains were not sustained through 12 months posttreatment. A smartphone app did not facilitate superior treatment outcomes. Future studies should consider factors impacting treatment efficacy in outpatient settings and the utility of providing more than six sessions of behavioral activation.
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Affiliation(s)
- Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States.
| | - Elizabeth D Reese
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Jennifer Y Yi
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Julianna M Maccarone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Zachary J Stewart
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
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Victor G, Zettner C, Huynh P, Ray B, Sightes E. Jail and overdose: assessing the community impact of incarceration on overdose. Addiction 2022; 117:433-441. [PMID: 34251065 DOI: 10.1111/add.15640] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/23/2021] [Accepted: 06/30/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Incarceration produces a specific public health threat for drug overdose, and correctional settings do not offer medication for opioid use disorder. This study examined the overall impact of jail incarceration on overdose, the specific hazard for those booked on a syringe-related charge and the proportion of all overdose decedents in the community who were in the jail prior to death. DESIGN AND SETTING A cohort study of fatal overdose outcomes among a sample of individuals booked into and released from jail between 1 January 2017 and 31 December 2019. Marion County, IN, USA. PARTICIPANTS All individuals released from one county jail between 1 January 2017 and 31 December 2017 and decedents who died within the county from an accidental fatal overdose between January 2017 and December 2019. MEASUREMENTS AND FINDINGS Using information on all jail booking events, including charge type, during a 5-year period (January 2015-December 2019), we looked at the hazard of accidental fatal overdose post-release, controlling for age, sex and race. Of all overdose deaths in the county, 21% (n = 237) had been in the county jail within 2 years prior to their death. Each prior booking increased the hazard of mortality by approximately 20% [hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.15, 1.28], while the presence of a syringe charge at most recent booking prior to release more than tripled the hazard of mortality (HR = 3.55, 95% CI = 2.55, 4.93). CONCLUSIONS In Marion County, IN, USA, there appears to be an association between increased risk of fatal drug overdose and both syringe-related arrests and repeat jail bookings.
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Affiliation(s)
- Grant Victor
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
| | - Catherine Zettner
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
| | - Philip Huynh
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
| | - Bradley Ray
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
| | - Emily Sightes
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
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Wong CY, Zhu W, Aurigemma GP, Furukawa N, Teshale EH, Huang YLA, Peters PJ, Hoover KW. Infective Endocarditis Among Persons Aged 18-64 Years Living with Human Immunodeficiency Virus, Hepatitis C Infection, or Opioid Use Disorder, United States, 2007-2017. Clin Infect Dis 2021; 72:1767-1781. [PMID: 32270861 DOI: 10.1093/cid/ciaa372] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a life-threatening bacterial infection of the heart valves, most often diagnosed in older persons and persons with prior cardiac surgery. It is also associated with injection drug use, a behavior that has increased in recent years along with the US opioid crisis. METHODS We conducted a retrospective cohort analysis of commercial and Medicaid health insurance databases to estimate incident cases of IE in the United States in 2017, stratified by persons living with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and opioid use disorder (OUD). We also estimated annual percentage changes (EAPCs) in IE from 2007-2017 among persons with commercial insurance. RESULTS The weighted incidence rate of IE was 13.8 cases per 100 000 persons among persons with commercial insurance, and 78.7 among those with Medicaid. The incidence rate of IE among commercially insured persons increased slightly from 2007-2017 (EAPC, 1.0%). It decreased among commercially insured persons living with HIV, from 148.0 in 2007 to 112.1 in 2017 (EAPC, -4.3%), and increased among those with HCV infection, from 172.4 in 2007 to 238.6 in 2017 (EAPC, 3.2%). Among persons aged 18-29 years with HCV infection, IE increased from 322.3 in 2007 to 1007.1 in 2017 (EAPC, 16.3%), and among those with OUD it increased from 156.4 in 2007 to 642.9 in 2017 (EAPC, 14.8%). CONCLUSIONS The incidence rate of IE increased markedly among young persons with HCV infections or OUD. This increase appears to parallel the ongoing national opioid crisis. Harm reduction with syringe services programs, medications for opioid use disorder, and safe injection practices can prevent the spread of HIV, HCV, and IE.
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Affiliation(s)
- Cecillia Y Wong
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Weiming Zhu
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Nathan Furukawa
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eyasu H Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ya-Lin A Huang
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Philip J Peters
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen W Hoover
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Watson DP, Swartz JA, Robison-Taylor L, Mackesy-Amiti ME, Erwin K, Gastala N, Jimenez AD, Staton MD, Messmer S. Syringe service program-based telemedicine linkage to opioid use disorder treatment: protocol for the STAMINA randomized control trial. BMC Public Health 2021; 21:630. [PMID: 33789642 PMCID: PMC8010496 DOI: 10.1186/s12889-021-10669-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/22/2021] [Indexed: 01/28/2023] Open
Abstract
Background A key strategy for mitigating the current opioid epidemic is expanded access to medications for treating opioid use disorder (MOUD). However, interventions developed to expand MOUD access have limited ability to engage opioid users at higher levels of overdose risk, such as those who inject opioids. This paper describes the study protocol for testing STAMINA (Syringe Service Telemedicine Access for Medication-assisted Intervention through NAvigation), an intervention that engages high-risk opioid users at community-based syringe service programs (SSP) and quickly links them to MOUD using a telemedicine platform. Methods This randomized control trial will be conducted at three SSP sites in Chicago. All participants will complete an initial assessment with a provider from a Federally Qualified Health Center who can prescribe or refer MOUD services as appropriate. The control arm will receive standard referral to treatment and the intervention arm will receive immediate telemedicine linkage to the provider and (depending on the type of MOUD prescribed) provided transportation to pick up their induction prescription (for buprenorphine or naltrexone) or attend their intake appointment (for methadone). We aim to recruit a total of 273 participants over two years to provide enough power to detect a difference in our primary outcome of MOUD treatment linkage. Secondary outcomes include treatment engagement, treatment retention, and non-MOUD opioid use. Data will be collected using structured interviews and saliva drug tests delivered at baseline, three months, and six months. Fixed and mixed effects generalized linear regression analyses and survival analysis will be conducted to compare the probabilities of a successful treatment linkage between the two arms, days retained in treatment, and post-baseline opioid and other drug use. Discussion If successful, STAMINA’s telemedicine approach will significantly reduce the amount of time between SSP clients’ initial indication of interest in the medication and treatment initiation. Facilitating this process will likely lead to stronger additional treatment- and recovery-oriented outcomes. This study is also timely given the need for more rigorous testing of telemedicine interventions in light of temporary regulatory changes that have occurred during the COVID-19 pandemic. Trial registration ClinicalTrials.gov (Clinical Trials ID: NCT04575324 and Protocol Number: 1138–0420). Registered 29 September 2020. The study protocol is also registered on the Open Science Framework (DOI 10.17605/OSF.IO/4853 M).
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Affiliation(s)
- Dennis P Watson
- Lighthouse Institute, Chestnut Health Systems, 221 W Walton St, Chicago, IL, 60610, USA.
| | - James A Swartz
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 W. Harrison St, Chicago, IL, 60607, USA
| | - Lisa Robison-Taylor
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois College of Medicine at Chicago, 818 S Wolcott Ave, Chicago, IL, 60612, USA
| | - Mary Ellen Mackesy-Amiti
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL, 60612, USA
| | - Kim Erwin
- Institute for Healthcare Delivery Design, University of Illinois at Chicago, 1220 S. Wood Street, Chicago, IL, 60612, USA
| | - Nicole Gastala
- Mile Square Health Centers, Department of Family Medicine, University of Illinois College of Medicine at Chicago, 1220 S Wood Street, Chicago, IL, 60608, USA
| | - Antonio D Jimenez
- Community Outreach Intervention Projects, University of Illinois - Chicago, School of Public Health, 1603 W. Taylor, Chicago, IL, 60612, USA
| | - Monte D Staton
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois College of Medicine at Chicago, 818 S Wolcott Ave, Chicago, IL, 60612, USA
| | - Sarah Messmer
- Departments of Academic Internal Medicine and Pediatrics, University of Illinois Chicago, 840 S Wood St, Chicago, IL, 60612, USA
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Kidorf M, Brooner RK, Leoutsakos JM, Peirce J. Reducing Risky Drug Use Behaviors by Enrolling Syringe Exchange Registrants in Methadone Maintenance. Subst Use Misuse 2021; 56:546-551. [PMID: 33616479 DOI: 10.1080/10826084.2021.1887253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Referral of syringe exchange registrants with opioid use disorder to agonist treatment provides a pathway to further reduce drug use risk behaviors. Objective: This study evaluates the drug use risk reduction benefits of enrolling syringe exchange registrants in methadone maintenance, and the impact of continued illicit drug use on risk reduction. Method: Baltimore Needle Exchange Program (BNEP) registrants (n = 210) participated in a parent study evaluating treatment initiation strategies for methadone maintenance and were followed for six months. The Risk Assessment Battery (RAB; Metzger, 1993) was administered monthly to evaluate drug use risks; urinalysis testing was conducted weekly. Results: Treatment enrollment reduced drug use risk behaviors, and longer treatment episodes resulted in additional, though modest, risk reduction. Use of opioids or cocaine in treatment diminished risk-reduction benefits, though drug use risks declined over time and remained well below baseline levels. Conclusions: These findings demonstrate that methadone maintenance enhances the well-known risk-reduction benefits of syringe exchange participation. Improving coordination between syringe exchanges and treatment facilities may enhance the public health.
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Affiliation(s)
- Michael Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert K Brooner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Peirce
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kidorf M, Latkin C, Brooner RK, Yan H, Peirce J. Developing a community-supported risk reduction intervention for syringe exchange registrants and their drug-free family or friends: a pilot study. J Addict Dis 2020; 39:248-256. [PMID: 33287681 DOI: 10.1080/10550887.2020.1854033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND People engaged in injection opioid use often have drug-free family or friends that could be mobilized to support risk reduction and treatment seeking. OBJECTIVE This pilot study evaluated the feasibility and preliminary efficacy of a 6-week community-supported risk reduction group intervention for syringe exchange program (SEP) registrants and drug-free network members. METHOD The group provided risk reduction and treatment readiness education, with weekly assignments for participants to engage together in community activities designed to meet other drug-free people. RESULTS Thirty-nine SEP registrants (and 39 community supports) enrolled in the study, and 21 pairs attended at least one group. For this smaller sample, participants attended 67% of scheduled sessions and engaged in scheduled activities during 42% of the study weeks, with 48% of SEP participants (n = 10) choosing to enter substance use disorder treatment. SEP participants who entered treatment reported reduced rates of injection drug use, opioid use, and cocaine use. CONCLUSIONS While this intervention shows promise for linking syringe exchange and substance use disorder treatment participation in select SEP registrants, outcomes demonstrating low demand and modest acceptability suggest that additional research is necessary to understand barriers to participation and motivate higher levels of engagement.
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Affiliation(s)
- Michael Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert K Brooner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haijuan Yan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica Peirce
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Sharp A, Barnett JT, Vroom EB. Community Perceptions of Harm Reduction and Its Implications for Syringe Exchange Policy. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620932289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the United States, the rising prevalence of opioid addiction has led to an increase in opioid-related overdose deaths and transmission of infectious disease. This resulted in the declaration of a national public health emergency and the need for harm reduction strategies such as syringe exchange. Florida has seen increases in blood-borne diseases and fatal/nonfatal opioid overdoses, yet harm reduction policy integration has been historically limited. To inform policy change, this study explores the perspectives of community members in Manatee County, Florida, on harm reduction services. Six focus groups were conducted with findings centralized around three emergent themes related to the implementation of a syringe exchange program: (a) awareness and acceptability; (b) facilitating factors; and (c) perceived barriers. The results of this qualitative research helped to inform the successful adoption of a local syringe exchange ordinance. Recommendations for community education and engagement regarding harm reduction policy are discussed.
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Affiliation(s)
| | - Joshua T. Barnett
- University of South Florida, Tampa, USA
- Manatee County Government, Bradenton, FL, USA
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Sightes E, Ray B, Paquet SR, Bailey K, Huynh P, Weintraut M. Police officer attitudes towards syringe services programming. Drug Alcohol Depend 2019; 205:107617. [PMID: 31707271 DOI: 10.1016/j.drugalcdep.2019.107617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND As the United States experiences a drug overdose epidemic, syringe services programs (SSPs) have been utilized to reduce rates of infectious disease and improve treatment outcomes for people who inject drugs (PWID). Police officer support of SSPs is crucial to program success. One way to improve officer support and collaboration is to develop officer training presentations about SSP services and procedures as well as information on officers' roles in program implementation. METHODS Researchers accompanied staff from the Marion County Safe Syringe Access and Support Program as they provided SSP training presentations to Indianapolis Metropolitan Police Department officers at district roll calls. Immediately following each presentation, officers completed a survey measuring attitudes toward SSPs, PWID, and the information presented. RESULTS Of the 339 completed surveys returned, most officers expressed support for the SSP and a desire to help PWID. However, those with experience of a needle stick injury were more critical of the program, reporting it enables drug use. Approximately half of respondents reported limited knowledge of SSPs, even after the training. Qualitative data indicate about half of officers reported they could use discretion in deciding whether to arrest for illegal possession of a syringe. CONCLUSIONS Overall findings indicate positive attitudes towards SSPs; however, officer feedback identifies several concerns and areas for improvement. Public health agencies must develop comprehensive, tailored presentations that address common officer concerns and misconceptions regarding SSPs, PWIDs, and harm reduction strategies to improve officer support.
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Affiliation(s)
- Emily Sightes
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI 48202, United States
| | - Bradley Ray
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI 48202, United States.
| | - Staci Rising Paquet
- O'Neill School of Public and Environmental Affairs, Center for Health and Justice Research, Indiana University Public Policy Institute, Indianapolis, IN 46202, United States
| | - Katie Bailey
- O'Neill School of Public and Environmental Affairs, Center for Health and Justice Research, Indiana University Public Policy Institute, Indianapolis, IN 46202, United States
| | - Philip Huynh
- O'Neill School of Public and Environmental Affairs, Center for Health and Justice Research, Indiana University Public Policy Institute, Indianapolis, IN 46202, United States
| | - Madison Weintraut
- Marion County Public Health Department, Infectious Disease, Indianapolis, IN 46205, United States
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Lovegrove MC, Dowell D, Geller AI, Goring SK, Rose KO, Weidle NJ, Budnitz DS. US Emergency Department Visits for Acute Harms From Prescription Opioid Use, 2016-2017. Am J Public Health 2019; 109:784-791. [PMID: 30896999 PMCID: PMC6459659 DOI: 10.2105/ajph.2019.305007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To estimate the number of US emergency department visits for prescription opioid harms by patient characteristics, intent, clinical manifestations, and active ingredient. METHODS We used data from medical record-based surveillance from a nationally representative 60-hospital sample. RESULTS Based on 7769 cases, there were 267 020 estimated emergency department visits annually (95% confidence interval [CI] = 209 833, 324 206) for prescription opioid harms from 2016 to 2017. Nearly half of visits (47.6%; 95% CI = 40.8%, 54.4%) were attributable to nonmedical opioid use, 38.9% (95% CI = 32.9%, 44.8%) to therapeutic use, and 13.5% (95% CI = 11.0%, 16.0%) to self-harm. Co-implication with other pharmaceuticals and concurrent illicit drug and alcohol use were common; prescription opioids alone were implicated in 31.5% (95% CI = 27.2%, 35.8%) of nonmedical use visits and 19.7% (95% CI = 15.7%, 23.7%) of self-harm visits. Unresponsiveness or cardiorespiratory failure (30.0%) and altered mental status (35.7%) were common in nonmedical use visits. Gastrointestinal effects (30.4%) were common in therapeutic use visits. Oxycodone was implicated in more than one third of visits across intents. CONCLUSIONS Morbidity data can help target interventions, such as dispensing naloxone to family and friends of those with serious overdose, and screening and treatment of substance use disorder when opioids are prescribed long-term.
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Affiliation(s)
- Maribeth C Lovegrove
- Maribeth C. Lovegrove, Andrew I. Geller, and Daniel S. Budnitz are with the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Deborah Dowell is with the National Center for Injury Prevention and Control, CDC. Sandra K. Goring and Kathleen O. Rose are with Northrup Grumman Corporation, Atlanta. Nina J. Weidle is with Eagle Medical Services LLC, Atlanta
| | - Deborah Dowell
- Maribeth C. Lovegrove, Andrew I. Geller, and Daniel S. Budnitz are with the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Deborah Dowell is with the National Center for Injury Prevention and Control, CDC. Sandra K. Goring and Kathleen O. Rose are with Northrup Grumman Corporation, Atlanta. Nina J. Weidle is with Eagle Medical Services LLC, Atlanta
| | - Andrew I Geller
- Maribeth C. Lovegrove, Andrew I. Geller, and Daniel S. Budnitz are with the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Deborah Dowell is with the National Center for Injury Prevention and Control, CDC. Sandra K. Goring and Kathleen O. Rose are with Northrup Grumman Corporation, Atlanta. Nina J. Weidle is with Eagle Medical Services LLC, Atlanta
| | - Sandra K Goring
- Maribeth C. Lovegrove, Andrew I. Geller, and Daniel S. Budnitz are with the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Deborah Dowell is with the National Center for Injury Prevention and Control, CDC. Sandra K. Goring and Kathleen O. Rose are with Northrup Grumman Corporation, Atlanta. Nina J. Weidle is with Eagle Medical Services LLC, Atlanta
| | - Kathleen O Rose
- Maribeth C. Lovegrove, Andrew I. Geller, and Daniel S. Budnitz are with the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Deborah Dowell is with the National Center for Injury Prevention and Control, CDC. Sandra K. Goring and Kathleen O. Rose are with Northrup Grumman Corporation, Atlanta. Nina J. Weidle is with Eagle Medical Services LLC, Atlanta
| | - Nina J Weidle
- Maribeth C. Lovegrove, Andrew I. Geller, and Daniel S. Budnitz are with the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Deborah Dowell is with the National Center for Injury Prevention and Control, CDC. Sandra K. Goring and Kathleen O. Rose are with Northrup Grumman Corporation, Atlanta. Nina J. Weidle is with Eagle Medical Services LLC, Atlanta
| | - Daniel S Budnitz
- Maribeth C. Lovegrove, Andrew I. Geller, and Daniel S. Budnitz are with the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Deborah Dowell is with the National Center for Injury Prevention and Control, CDC. Sandra K. Goring and Kathleen O. Rose are with Northrup Grumman Corporation, Atlanta. Nina J. Weidle is with Eagle Medical Services LLC, Atlanta
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Kidorf M, Brooner RK, Leoutsakos JM, Peirce J. Treatment initiation strategies for syringe exchange referrals to methadone maintenance: A randomized clinical trial. Drug Alcohol Depend 2018; 187:343-350. [PMID: 29709732 DOI: 10.1016/j.drugalcdep.2018.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 11/26/2022]
Abstract
This randomized clinical trial evaluated the efficacy of three treatment initiation strategies for improving retention to methadone maintenance for opioid-dependent individuals referred from a syringe exchange program (SEP). New admissions (n = 212) were randomly assigned to one of three 3-month initiation strategies: 1) Low Threshold (LTI), 2) Voucher Reinforcement (VRI), or 3) Standard Care (SCI). LTI was modeled on interim methadone maintenance to transition SEP admissions to the structure of medication-assisted treatment while maximizing exposure to methadone pharmacotherapy. VRI used monetary incentives to reinforce adherence to pharmacotherapy and adaptive counseling. SCI participants received standard methadone dosing and adaptive counseling. All participants were stabilized on methadone pharmacotherapy with a target dose of 80 mg. Following the initiation phase, participants in each condition received standard adaptive counseling from months 4-6. Results showed that most participants failed to achieve the target methadone dose. While no condition differences were observed in retention rates over the 3-month and 6-month observation periods, participants across conditions exhibited reductions in objective and self-report measures of drug use. Results support the benefits of referring syringe exchangers to methadone maintenance, and demonstrate the challenge of retaining these individuals in treatment.
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Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, United States.
| | - Robert K Brooner
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, United States
| | - Jeannie-Marie Leoutsakos
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, United States
| | - Jessica Peirce
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, United States
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O'Grady CL, Surratt HL, Kurtz SP, Levi-Minzi MA. Nonmedical prescription drug users in private vs. public substance abuse treatment: a cross sectional comparison of demographic and HIV risk behavior profiles. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:9. [PMID: 24495784 PMCID: PMC3915073 DOI: 10.1186/1747-597x-9-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/12/2013] [Indexed: 11/10/2022]
Abstract
Background Little is known regarding the demographic and behavioral characteristics of nonmedical prescription drug users (NMPDUs) entering substance abuse treatment settings, and information on the HIV-related risk profiles of NMPDUs is especially lacking. Participation in substance abuse treatment provides a critical opportunity for HIV prevention and intervention, but successful initiatives will require services appropriately tailored for the needs of NMPDUs. Methods This paper compares the HIV risk profiles of NMPDUs in public (n = 246) and private (n = 249) treatment facilities. Participants included in the analysis reported five or more recent episodes of nonmedical prescription drug use, a prior HIV negative test result, and current enrollment in a substance abuse treatment facility. A standardized questionnaire was administered by trained interviewers with questions about demographics, HIV risk, and substance use. Results Private treatment clients were more likely to be non-Hispanic White, younger, and opioid and heroin users. Injection drug use was higher among private treatment clients, whereas public clients reported higher likelihood of trading or selling sex. Public treatment clients reported higher rates of HIV testing and availability at their treatment facilities compared to private clients. Conclusions Findings suggest differing demographics, substance use patterns, profiles of HIV risk and access to HIV testing between the two treatment samples. Population tailored HIV interventions, and increased access to HIV testing in both public and private substance treatment centers, appear to be warranted.
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Affiliation(s)
- Catherine L O'Grady
- ARSH: Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 2 NE 40th Street, Suite 404, Miami, FL 33137, USA.
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Gjersing L, Bretteville-Jensen AL. Is opioid substitution treatment beneficial if injecting behaviour continues? Drug Alcohol Depend 2013; 133:121-6. [PMID: 23773951 DOI: 10.1016/j.drugalcdep.2013.05.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/15/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Opioid substitution treatment (OST) is recognised as an effective treatment for opioid dependence. Still, a subgroup of OST users continues to inject drugs. This study examines health risks and criminal activity in a population of needle exchange programme (NEP) participants by comparing those identified as current OST users to (i) those identified as former OST users and (ii) those with no OST experience. METHODS This was a semi-annual cross-sectional study conducted from 2002 to 2011. NEP participants were interviewed in Oslo, Norway (n=1760); 341 were identified as current OST users, 356 as former OST users and 1063 had no OST experience. The associations between OST status and health risk and criminal activity were assessed through univariate and multiple logistic regression analyses. RESULTS Among NEP participants, those currently in OST had fewer non-fatal overdoses (OR=0.5 [95% CI 0.3, 0.9]) compared to former OST users and those never in OST. Additionally, they were less likely to have injected frequently (OR=0.4 [95% CI 0.3, 06]), to have used heroin daily or almost daily (OR=0.3 [95% CI 0.2, 0.4]), and to have committed theft (OR=0.6 [95% CI 0.4, 1.0]) and engaged in drug dealing (OR=0.7 [95% CI 0.5, 0.9]) in the past month. Overall, there was a high level of polysubstance use and no group differences on this measure. CONCLUSIONS NEP participants who are currently in OST have substantially reduced health risks and criminal activity than other NEP participants. The high level of polysubstance use nevertheless poses a public health challenge.
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Affiliation(s)
- Linn Gjersing
- Norwegian Institute for Alcohol and Drug Research (SIRUS), PB 565 Sentrum, 0105 Oslo, Norway.
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Kidorf M, King VL, Peirce J, Kolodner K, Brooner RK. An Observation of Lower Rates of Drug Use over Time in Community Syringe Exchangers. Am J Addict 2013; 22:271-6. [DOI: 10.1111/j.1521-0391.2012.12002.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 02/28/2012] [Accepted: 08/20/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- Michael Kidorf
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins University School of Medicine; Baltimore, Maryland
| | - Van L. King
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins University School of Medicine; Baltimore, Maryland
| | - Jessica Peirce
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins University School of Medicine; Baltimore, Maryland
| | - Ken Kolodner
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins University School of Medicine; Baltimore, Maryland
| | - Robert K. Brooner
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins University School of Medicine; Baltimore, Maryland
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18
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Kidorf M, King VL, Gandotra N, Kolodner K, Brooner RK. Improving treatment enrollment and re-enrollment rates of syringe exchangers: 12-month outcomes. Drug Alcohol Depend 2012; 124:162-6. [PMID: 22209388 PMCID: PMC3341500 DOI: 10.1016/j.drugalcdep.2011.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Developing bridges between community syringe exchange programs (SEPs) and substance abuse treatment could benefit syringe exchangers and the public health. Kidorf et al. (2009) showed that motivational approaches employed at an SEP site improved rates of treatment enrollment and reduced drug use over a 4-month observation window. The present study extends this report by evaluating rates of treatment enrollment and re-enrollment over a 12-month period. METHODS Opioid dependent individuals (n = 281) newly registered at an SEP were randomly assigned to one of three referral interventions: (1) 8 individual motivational enhancement sessions and 16 treatment readiness group sessions designed to improve treatment interest and readiness (motivated referral condition; MRC-only); (2) MRC-only with monetary incentives for attending sessions and enrolling in treatment (MRC+I); or (3) standard referral (SRC). MRC-only and MRC+I participants discharged from treatment could attend a treatment re-engagement group designed to facilitate return to treatment (MRC+I participants received incentives for attending sessions and re-enrolling in treatment). RESULTS The 4-month outcomes generally extended over 12 months. MRC+I participants were more likely to enroll in methadone maintenance than MRC-only or SRC participants, and to re-enroll in treatment following discharge. MRC+I participants also reported more days of treatment and less heroin and injection use. CONCLUSIONS The good harm reduction outcomes for many SEP participants can be enhanced through strategies designed to facilitate treatment enrollment and re-enrollment.
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Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD 21224, United States.
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Trenz R, Penniman T, Scherer M, Zur J, Rose J, Latimer W. Problem recognition, intention to stop use, and treatment use among regular heroin injectors. J Subst Abuse Treat 2012; 43:204-10. [PMID: 22301081 DOI: 10.1016/j.jsat.2011.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 11/16/2011] [Accepted: 12/12/2011] [Indexed: 11/18/2022]
Abstract
This study investigated frequency of recent use as an explanatory variable in problem recognition and intention to stop use among regular injection heroin users. Data from the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors for HIV and hepatitis A, B, and C among injection and noninjection drug users, were used in the analyses. Participants (N = 337) consisted of those who reported injecting heroin daily or nearly daily for a period of 3 months. Multiple linear regression analysis revealed that frequency of recent injection drug use predicted problem recognition (β = .17), but not intention to stop use; although marginal, being female (β = .15), and homeless (β = .14) contributed to intention to stop use. Past 6-month treatment participation was 48%, and current treatment enrollment was 26% among study participants. This study highlights the importance of capitalizing on injection drug users' recent use as a mechanism for treatment interventions.
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Affiliation(s)
- Rebecca Trenz
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Volkow ND, Montaner J. The urgency of providing comprehensive and integrated treatment for substance abusers with HIV. Health Aff (Millwood) 2011; 30:1411-9. [PMID: 21821558 DOI: 10.1377/hlthaff.2011.0663] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Substance abuse is linked to many new cases of HIV infection. Barriers such as the myth that drug users cannot adhere to HIV/AIDS treatment block progress in curbing the spread of HIV in that population. In this article we explain the need to aggressively seek out high-risk, hard-to-reach substance abusers and to offer them HIV testing, access to treatment, and the necessary support to remain in treatment--both for HIV and for substance abuse. We summarize evidence showing that injection drug users can successfully undergo HIV treatment; that many substance abusers adhere to antiretroviral therapy as well as do people who don't inject drugs; and that injection drug users who undergo substance abuse treatment are more likely to obtain and stay in treatment for their HIV infection. This evidence makes a strong case for integrating substance abuse treatment with HIV treatment programs and providing substance abusers with universal access to HIV treatment. But an integrated strategy will require changes in the health care system to overcome lingering obstacles that inhibit the merging of substance abuse treatment with HIV programs.
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Affiliation(s)
- Nora D Volkow
- National Institute on Drug Abuse, Bethesda, Maryland, USA.
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