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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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2
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Lancaster KE, Cooper HLF, Browning CR, Malvestutto CD, Bridges JFP, Young AM. Syringe Service Program Utilization, Barriers, and Preferences for Design in Rural Appalachia: Differences between Men and Women Who Inject Drugs. Subst Use Misuse 2020; 55:2268-2277. [PMID: 32748730 PMCID: PMC7584727 DOI: 10.1080/10826084.2020.1800741] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background People who inject drugs (PWID) in rural areas of the United States have had limited access to syringe service programs (SSP). Rural SSP have recently surged, but accompanying research is lacking about PWID utilization, barriers, and preferences for SSP design and how those preferences vary by gender. Methods: Interviewer-administered surveys elicited information about utilization, barriers, and preferences for SSP design from 234 PWID recruited using respondent-driven sampling in Appalachian, Kentucky. Gender differences among reported barriers to utilizing SSP and preferences for program design were explored using Mantel-Haenszel chi-square tests. Results: Overall, 49% of PWID had ever utilized an SSP. The most common reasons for not utilizing an SSP were lack of awareness (23%), fear of being seen or disclosing drug use (19%), and lack of need (19%). The most preferred SSP design was located within a health department (74%) and operating during afternoon hours (66%). Men were more likely than women to prefer SSP in health departments (80% vs. 65%, p = 0.01), while more women than men preferred staffing by health department personnel (62% vs. 46%, p = 0.02). Women were less likely to favor evening hours (55% vs. 70%, p = 0.02). Fewer women wanted SSP nurses (78% vs. 90%, p = 0.01), social workers (11% vs. 24%, p = 0.01), or people who use drugs (20% vs 34%, p = 0.02) to staff SSP. Conclusions: Despite recent scale-up, SSP in Appalachia remain under-utilized. PWID were open to a range of options for SSP design and staffing, though there were variations by gender. Implementation research that identifies best strategies for tailored SSP scale-up in rural settings should be considered.
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Affiliation(s)
- Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Carlos D Malvestutto
- Division of Infectious Diseases, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - John F P Bridges
- Departments of Biomedical Informatics and Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA.,Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
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3
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Surratt HL, Otachi JK, Williams T, Gulley J, Lockard AS, Rains R. Motivation to Change and Treatment Participation Among Syringe Service Program Utilizers in Rural Kentucky. J Rural Health 2019; 36:224-233. [PMID: 31415716 DOI: 10.1111/jrh.12388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/21/2019] [Accepted: 07/16/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Kentucky experiences a disproportionate burden of substance use disorder (SUD), particularly in rural areas of the state. Multiple factors increase vulnerability to SUD and limit access to services in rural communities. However, the recent implementation and expansion of syringe service programs (SSPs) in rural Kentucky may provide a leverage point to reach at-risk people who inject drugs (PWID). METHODS Data were collected as part of an ongoing NIDA-funded study designed to examine uptake of SSPs among PWID in Appalachian Kentucky. Using Respondent Driven Sampling (RDS), the study enrolled a sample of 186 PWID SSP attenders across 3 rural Appalachian Kentucky counties and conducted face-to-face interviews regarding health behaviors, injecting practices, SSP utilization, and treatment services. Using logistic regression analyses, we examined consistent SSP use, as well as importance and confidence to reduce substance use as predictors of current treatment participation. FINDINGS For the prior 6 months, 44.6% of the sample reported consistent SSP use. Consistent use of SSPs was associated with treatment participation in the unadjusted logistic regression models. Significant predictors of treatment participation in the adjusted model included high confidence to reduce substance use, and not reporting primary methamphetamine injection. CONCLUSIONS Rurally located SSPs may play an important role in supporting confidence and motivation to change substance use behaviors among PWID impacted by SUD. SSPs may be critical venues for integration and expansion of prevention, health promotion, and treatment linkage services for this underserved population.
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Affiliation(s)
- Hilary L Surratt
- Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Janet K Otachi
- Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Timothy Williams
- Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, Kentucky
| | | | | | - Rebecca Rains
- Knox County Health Department, Barbourville, Kentucky
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4
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Interest in Getting Help to Reduce or Stop Substance Use Among Syringe Exchange Clients Who Use Opioids. J Addict Med 2018; 12:428-434. [DOI: 10.1097/adm.0000000000000426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Fox AD, Sohler NL, Frost T, Lopez C, Cunningham CO. Development and evaluation of a community-based buprenorphine treatment intervention. Harm Reduct J 2017; 14:23. [PMID: 28499432 PMCID: PMC5427587 DOI: 10.1186/s12954-017-0149-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/18/2017] [Indexed: 11/12/2022] Open
Abstract
Background The majority of Americans with opioid use disorder remain out of treatment. Operating in 33 states, Washington DC, and Puerto Rico, harm reduction agencies, which provide sterile syringes and other health services to people who inject drugs, are a key venue to reach out-of-treatment opioid users. Aiming to link out-of-treatment individuals with opioid use disorder to buprenorphine treatment, we developed a community-based buprenorphine treatment (CBBT) intervention in collaboration with New York City harm reduction agencies. Methods Intervention development included formative data collection, feasibility testing at one harm reduction agency, and pilot testing for preliminary effectiveness at a second harm reduction agency. We used a pre-post design for both feasibility and pilot testing. In the CBBT intervention, we trained harm reduction agency staff to provide (1) buprenorphine education, (2) motivational interviewing, (3) referrals to buprenorphine-prescribing doctors, and (4) treatment retention support. We assessed feasibility by measuring staff satisfaction with the intervention and changes in knowledge about buprenorphine. We assessed preliminary effectiveness by comparing rates of buprenorphine initiation among groups of harm reduction agency clients before and after intervention implementation. Results Among staff members at the first harm reduction agency, knowledge increased from 52% correct answers pre-intervention to 79% correct post-intervention. Among clients at the second harm reduction agency, initiation of buprenorphine treatment was low and did not differ between pre- and post-intervention groups. Conclusions The CBBT intervention was feasible and well-received, but initiation of buprenorphine treatment among harm reduction agency clients was low. More robust interventions may be necessary to increase initiation of buprenorphine treatment.
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Affiliation(s)
- Aaron D Fox
- Albert Einstein College of Medicine, Bronx, NY, 10461, USA. .,Montefiore Medical Center, 111 E. 210th Street, Bronx, NY, 10467, USA.
| | - Nancy L Sohler
- City College of New York, Sophie Davis School of Biomedical Education, New York, NY, 10031, USA
| | - Taeko Frost
- Washington Heights CORNER Project, New York, NY, 10033, USA
| | - Carolina Lopez
- New York Harm Reduction Educators, New York, NY, 10035, USA
| | - Chinazo O Cunningham
- Albert Einstein College of Medicine, Bronx, NY, 10461, USA.,Montefiore Medical Center, 111 E. 210th Street, Bronx, NY, 10467, USA
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6
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Meyerson BE, Lawrence CA, Miller L, Gillespie A, Raymond D, Kelley K, Shannon DJ. Against the Odds: Syringe Exchange Policy Implementation in Indiana. AIDS Behav 2017; 21:973-981. [PMID: 28108875 DOI: 10.1007/s10461-017-1688-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Indiana recently passed legislation allowing local governments to establish syringe exchanges. While the effectiveness of syringe exchange programming is established, there is a dearth of studies about associated policy adoption and implementation. This study documents the experiences of 24 Indiana counties engaged in the process of establishing syringe exchange programming under new state law. A mixed method, qualitative, exploratory case study was conducted from May 2015 to April 2016. We observed rapid and widespread policy adoption interest, and yet counties reported significant policy ambiguity, epidemiologic and resource capacity issues. The emergence of health commons involving information and tangible resource sharing networks allowed institutional rearrangement in the midst of resource scarcity; however, such rearrangement appeared to be a central threat to policy adoption and implementation given state structural barriers. The emerging commons could be a critical policy success factor, as it would achieve efficiencies not possible in the current resource environment, and can help achieve institutional rearrangement for the improvement of population health. Several recommendations for improvement are offered.
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Affiliation(s)
- Beth E Meyerson
- Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, USA.
| | - Carrie A Lawrence
- Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, USA
| | - Laura Miller
- Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, USA
| | - Anthony Gillespie
- Indiana Minority Health Coalition, 3737 North Meridian Street, Indianapolis, IN, 46208, USA
| | - Daniel Raymond
- Harm Reduction Coalition, 22 West 27th Street, 5th Floor, New York, NY, 10001, USA
| | - Kristen Kelley
- Prescription Drug Abuse Prevention Task Force, Office of the Indiana Attorney General, 302 West Washington Street, 5th Floor, Indianapolis, IN, 46204, USA
| | - D J Shannon
- Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, USA
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7
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Bråbäck M, Ekström L, Troberg K, Nilsson S, Isendahl P, Brådvik L, Håkansson A. Malmö Treatment Referral and Intervention Study-High 12-Month Retention Rates in Patients Referred from Syringe Exchange to Methadone or Buprenorphine/Naloxone Treatment. Front Psychiatry 2017; 8:161. [PMID: 28912734 PMCID: PMC5583161 DOI: 10.3389/fpsyt.2017.00161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/14/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Heroin dependence is associated with high mortality. Opioid agonist treatment (OAT) with methadone or buprenorphine has strong evidence for treatment of this relapsing condition. In our setting, OAT has been associated with strict and demanding intake procedures, often with requirements of social stability, but also high, approximately 80 percent 12-month retention rates. In a recent randomized controlled trial, we demonstrated high rates of successful rapid referral from a syringe exchange programme (SEP) to treatment with methadone or buprenorphine, including actual treatment initiation. The objectives of this study were to assess 12-month retention rates, in order to assess whether a novel referral program of current drug users at a SEP would achieve retention rates comparable to more traditional intake procedures. METHODS The present report is a 12-month follow-up of 71 patients who successfully started treatment with methadone or buprenorphine/naloxone. Patient data from baseline and at 12 months were collected. RESULTS Out of the 71 patients who started treatment, 58 (82%) were still in treatment after 12 months. CONCLUSION This was a population, referred from a SEP, with a high drug use severity on admission and no pretreatment requirement for social stability, but there were still high retention rates at 12 months comparable to regular opioid agonist clinics in our setting.
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Affiliation(s)
- Martin Bråbäck
- Addiction Center Malmö, Division of Psychiatry, Malmö, Sweden.,Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden
| | - Lars Ekström
- Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden.,Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katja Troberg
- Addiction Center Malmö, Division of Psychiatry, Malmö, Sweden.,Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden
| | - Suzan Nilsson
- Addiction Center Malmö, Division of Psychiatry, Malmö, Sweden.,Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden
| | - Pernilla Isendahl
- Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden.,Department of Infectious Diseases, University Hospital Skåne, Malmö, Sweden
| | - Louise Brådvik
- Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden
| | - Anders Håkansson
- Addiction Center Malmö, Division of Psychiatry, Malmö, Sweden.,Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden
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8
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Jones DJ. HIV Risk-Reduction Strategies for Substance Abusers: Effecting Behavior Change. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798403259246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Substance abuse has a strong link to HIV/AIDS in the United States. Use and abuse of alcohol and other drugs often reduce inhibitions and encourage engagement in high-risk sexual behaviors that can ultimately result in HIV and AIDS. The HIV/AIDS epidemic in the United States has disproportionately affected minorities with African Americans being the group hardest hit. This article presents some of the behavioral, social, and psychological factors that influence the risk for drug use. It highlights and assesses the effectiveness of HIV risk-reduction strategies developed for drug-using populations and makes recommendations for a more holistic and integrated approach utilizing multiple interventions at multiple levels.
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Affiliation(s)
- Dionne J. Jones
- National Institute on Drug Abuse, National Institutes of Health
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9
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Bråbäck M, Nilsson S, Isendahl P, Troberg K, Brådvik L, Håkansson A. Malmö Treatment Referral and Intervention Study (MATRIS)—effective referral from syringe exchange to treatment for heroin dependence: a pilot randomized controlled trial. Addiction 2016; 111:866-73. [PMID: 26613636 DOI: 10.1111/add.13249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 09/17/2015] [Accepted: 11/10/2015] [Indexed: 11/30/2022]
Abstract
AIMS Syringe exchange has been suggested as a potential conduit to treatment for drug dependence, but this has never been documented in Europe. The primary aim was to compare the effectiveness of strength-based case management intervention (CMI) against referral only to facilitate treatment attendance in a syringe exchange programme. We also assessed the effectiveness of a syringe exchange programme for referral of heroin-dependent patients to evidence-based treatment with methadone or buprenorphine (buprenorphine-naloxone). DESIGN Single-site, two-group randomized controlled trial. SETTING The syringe exchange programme in Malmö, Sweden and an out-patient clinic (research treatment facility) for maintenance treatment, situated outside the hospital area and run by Malmö Addiction Centre. PARTICIPANTS Heroin-dependent patients willing to participate (n = 75) were referred to maintenance treatment and randomized to either a strength-based case management intervention aiming to facilitate referral (n = 36) or to referral-only (n = 39). INTERVENTION The intervention group received an appointment for maintenance treatment and a CMI adjusted to individual patient needs. The CMI was semi-structured, assessing the patients' strengths and needs and identifying what practical help they might need to get to the appointment for maintenance treatment. The control group received an appointment for maintenance treatment. MEASURES The primary outcome was treatment entry. FINDINGS Among patients who turned up for recruitment interview and randomization, the percentage of patients who started treatment was 95% in the intervention group and 94% in the control group. Treatment entry was unrelated to intervention status [unadjusted odds ratio (OR) = 0.92 (0.12–6.89), P = 1.00 and adjusted OR = 0.96 (0.12–7.83)]. CONCLUSIONS A randomized controlled trial in a syringe exchange programme showed no evidence that a strength-based case management intervention improved attendance for treatment over referral alone. Attendance rates were high in both groups.
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Affiliation(s)
- Martin Bråbäck
- Addiction Center Malmö; Psychiatry Skåne; Malmö Sweden
- Department of Clinical Sciences Lund, Division of Psychiatry; Lund University; Lund Sweden
| | - Suzan Nilsson
- Addiction Center Malmö; Psychiatry Skåne; Malmö Sweden
- Department of Clinical Sciences Lund, Division of Psychiatry; Lund University; Lund Sweden
| | - Pernilla Isendahl
- Department of Clinical Sciences Lund, Division of Psychiatry; Lund University; Lund Sweden
- Department of Infectious Diseases; University Hospital Skåne; Malmö Sweden
| | - Katja Troberg
- Addiction Center Malmö; Psychiatry Skåne; Malmö Sweden
- Department of Clinical Sciences Lund, Division of Psychiatry; Lund University; Lund Sweden
| | - Louise Brådvik
- Department of Clinical Sciences Lund, Division of Psychiatry; Lund University; Lund Sweden
| | - Anders Håkansson
- Addiction Center Malmö; Psychiatry Skåne; Malmö Sweden
- Department of Clinical Sciences Lund, Division of Psychiatry; Lund University; Lund Sweden
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10
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Philbin MM, FuJie Z. Exploring stakeholder perceptions of facilitators and barriers to using needle exchange programs in Yunnan Province, China. PLoS One 2014; 9:e86873. [PMID: 24498286 PMCID: PMC3911934 DOI: 10.1371/journal.pone.0086873] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 12/17/2013] [Indexed: 11/18/2022] Open
Abstract
Injection drug use is an ongoing urban health crisis in China and one of the largest drivers of the transmission of HIV/AIDS. Sentinel surveillance sites in Yunnan province show upwards of 20% of injection drug users (IDUs) are HIV positive. Though the Ministry of Health has scaled-up needle exchange programs (NEPs), they have not received official government recognition nor have they been extensively evaluated to explore factors influencing their acceptability and feasibility. Using in-depth qualitative interviews conducted from February to July 2008 with 35 participants consisting of IDUs and other key stakeholders, we explored facilitators and barriers to accessing needle exchange programs in Kunming, the capital of Yunnan province. Content analysis was conducted to identify themes including attitudes toward NEPs and harm reduction, barriers to access, and suggestions for improvement. Themes that emerged included fears of breached confidentiality and police interference at the exchange sites and tensions between the public health and law enforcement perspective. Low levels of NEP-related knowledge and awareness were uniformly reported among interviewees. Suggestions to facilitate an increase in NEP acceptance included raising awareness of harm reduction and HIV more generally, offering services such as psychological counseling, job training and behavioral therapy at NEPs, and increasing communication between police, government, and public health officials. High rates of HIV infection among injection drug users in China have prompted rapid scale up of NEPs. Additional adaptations are necessary, however, to increase needle exchange use among injection drug users. This study finds that an urgent need to raise awareness of NEPs among policy makers and IDUs and act upon identified steps for developing social-structural interventions to create enabling environments that facilitate increased access to NEPs among injection drug users in Kunming.
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Affiliation(s)
- Morgan M. Philbin
- HIV Center for Clinical & Behavioral Studies Columbia University and the NY State Psychiatric Institute, New York City, New York, United States of America
- * E-mail:
| | - Zhang FuJie
- Treatment and Care Division, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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11
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Tyndall MW. Impact of supervised injection facilities on community HIV levels: a public health perspective. Expert Rev Anti Infect Ther 2014; 1:543-9. [PMID: 15482151 DOI: 10.1586/14787210.1.4.543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The health and social consequences of intravenous drug use pose major challenges to cities across North America. Preventable drug-related harms including accidental overdose, serious bacterial infections, injuries of violence and more recently, the emergence of HIV and hepatitis C, have major impacts on community health. Among the various interventions designed to reduce the harms associated with injection drug use, the establishment of a supervised injection facility is perhaps the most controversial. This review will focus on the potential impact of supervised injection facilities on HIV transmission in conjunction with current HIV prevention initiatives. This will include a review of the health and social consequences associated with illicit drugs use, the limitations of drug enforcement, and the potential impact of supervised injection facilities on reducing the harms associated with injection drug use.
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Affiliation(s)
- Mark W Tyndall
- Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada.
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12
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Abstract
HIV research has identified approaches that can be combined to be more effective in transmission reduction than any 1 modality alone: delayed adolescent sexual debut, mutual monogamy or sexual partner reduction, correct and consistent condom use, pre-exposure prophylaxis with oral antiretroviral drugs or vaginal microbicides, voluntary medical male circumcision, antiretroviral therapy (ART) for prevention (including prevention of mother to child HIV transmission [PMTCT]), treatment of sexually transmitted infections, use of clean needles for all injections, blood screening prior to donation, a future HIV prime/boost vaccine, and the female condom. The extent to which evidence-based modalities can be combined to prevent substantial HIV transmission is largely unknown, but combination approaches that are truly implementable in field conditions are likely to be far more effective than single interventions alone. Analogous to PMTCT, "treatment as prevention" for adult-to-adult transmission reduction includes expanded HIV testing, linkage to care, antiretroviral coverage, retention in care, adherence to therapy, and management of key co-morbidities such as depression and substance use. With successful viral suppression, persons with HIV are far less infectious to others, as we see in the fields of sexually transmitted infection control and mycobacterial disease control (tuberculosis and leprosy). Combination approaches are complex, may involve high program costs, and require substantial global commitments. We present a rationale for such investments and cite an ongoing research agenda that seeks to determine how feasible and cost-effective a combination prevention approach would be in a variety of epidemic contexts, notably that in a sub-Saharan Africa.
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Affiliation(s)
- Sten H Vermund
- Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt School of Medicine, Nashville, TN 37203, USA.
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13
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A latent class approach to treatment readiness corresponds to a transtheoretical ("Stages of Change") model. J Subst Abuse Treat 2013; 45:249-56. [PMID: 23706606 DOI: 10.1016/j.jsat.2013.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 03/28/2013] [Accepted: 04/08/2013] [Indexed: 11/22/2022]
Abstract
Motivation for treatment among people with substance use problems is an important aspect of treatment success. Models for treatment motivation are widely debated. Latent Class Analysis can help to demonstrate the appropriateness of available models. The current study utilizes Latent Class Analysis to analyze treatment readiness statements as they relate to the reduction or cessation of marijuana, cocaine, and opioid use among 539 cocaine and opioid users recruited from the community of Baltimore, MD, USA. Participants completed an in-person structured interview including demographic questions, a treatment readiness questionnaire with items on Intention to Stop Use (ISU) and Problem Recognition (PR), current substance abuse treatment utilization, and urinalysis testing for marijuana, cocaine, and heroin. Latent class models were fit to the treatment readiness questionnaire. A four-class model provided the best fit with one class low on both ISU and PR ("Pre-contemplative"), a second class low on ISU but high on PR ("Contemplative"), a third class high on both ("Preparation/Action"), and a final class high on ISU but low on PR ("Post-Action"). Compared to the "Contemplative" class, the "Pre-contemplative" class was significantly more likely to be positive for marijuana, and the "Post-Action" class was significantly less likely to be positive for opioids. The "Preparation/Action" class was significantly more likely to be in treatment. With the exception of the "Post-Action" class, the analysis appears similar to the "Stages of Change" model and suggests that problem recognition and intention to stop use are important domains in the model. However, further longitudinal research is needed to assess predictive validity of model.
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Smith K, Bartlett N, Wang N. A harm reduction paradox: comparing China's policies on needle and syringe exchange and methadone maintenance. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:327-32. [PMID: 22377341 PMCID: PMC7135432 DOI: 10.1016/j.drugpo.2011.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 09/09/2011] [Accepted: 09/24/2011] [Indexed: 11/18/2022]
Abstract
Background China has launched methadone maintenance treatment (MMT) and needle and syringe exchange programmes (NSEP) as part of the country's HIV prevention strategy amongst injection drug users. MMT is expanding, with backing from multiple government ministries, however, NSEP have received less political support and funding. Methods Semi-structured, serial interviews were conducted with key informants, knowledgeable about China's harm reduction policies. Concurrent content analysis allowed for revision of the interview guide throughout the data collection process. This was combined with a systematic analysis of official government policy documents on NSEP and MMT, including white papers, legal documents, and policy statements. Findings Early consensus between public security and public health sectors regarding methadone's dual use in HIV prevention as well as method of drug control created broad institutional support for MMT programmes amongst policy makers. In contrast, NSEP were seen as satisfying only the HIV prevention goals of the public health sector, and were perceived as condoning illicit drug use. Furthermore, NSEP's roots in China, as an experimental collaboration with international groups, created suspicion regarding its role in China's drug control policy. NSEP and MMT's distinct paths to policy development are reflected in the complex and occasionally contradictory nature of China's harm reduction strategy. Conclusions These discrepancies highlight the need for a more politically sustainable and comprehensive integration of harm reduction projects. Recommendations include improved evaluation methods for NESP, NSEP-MMT cross-referral system, and stronger NSEP advocacy within the non-profit and public health sectors.
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Affiliation(s)
- Kumi Smith
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
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15
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Mehta SH, Sudarshi D, Srikrishnan AK, Celentano DD, Vasudevan CK, Anand S, Kumar MS, Latkin C, Solomon S, Solomon SS. Factors associated with injection cessation, relapse and initiation in a community-based cohort of injection drug users in Chennai, India. Addiction 2012; 107:349-58. [PMID: 21815960 PMCID: PMC3222716 DOI: 10.1111/j.1360-0443.2011.03602.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS To characterize factors associated with injection cessation, relapse and initiation. DESIGN The Madras Injection Drug User and AIDS Cohort Study (MIDACS) is a prospective cohort of injection drug users (IDUs) recruited in 2005-06 with semi-annual follow-up to 2009. Discrete-time survival models were used to characterize predictors of time to first injection cessation and relapse. SETTING Chennai, India. PARTICIPANTS A total of 855 IDUs who reported injecting in the 6 months prior to baseline and had >1 follow-up visit. MEASUREMENTS Cessation was defined as the first visit where no injection drug use was reported (prior 6 months) and relapse as the first visit where drug injection (prior 6 months) was reported after first cessation. FINDINGS All participants were male; median age was 35 years. Over 3 years, 92.7% reported cessation [incidence rate (IR): 117 per 100 person-years]. Factors associated positively with cessation included daily injection and incarceration and factors associated negatively with cessation included marriage, alcohol and homelessness. Of those who reported cessation, 23.6% relapsed (IR: 19.7 per 100 person-years). Factors associated positively with relapse included any education, injection in the month prior to baseline, sex with a casual partner, non-injection drug use, incarceration and homelessness. Alcohol was associated negatively with relapse. The primary reasons for cessation were medical conditions (37%) and family pressure (22%). The majority initiated with non-injection drugs, transitioning to injection after a median 4 years. CONCLUSIONS Injection drug users in southern India demonstrate a high rate of injection cessation over 3 years, but relapse is not uncommon. Compensatory increases in alcohol use indicate that cessation of injection does not mean cessation of all substance use. Family pressure, concerns about general health, fear of human immunodeficiency virus infection and a history of non-injection drug use are important correlates of cessation.
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Affiliation(s)
- Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Darshan Sudarshi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - David D. Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
| | | | - Carl Latkin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Suniti Solomon
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
| | - Sunil S. Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA,YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
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Gervasoni JP, Balthasar H, Huissoud T, Jeannin A, Dubois-Arber F. A high proportion of users of low-threshold facilities with needle exchange programmes in Switzerland are currently on methadone treatment: implications for new approaches in harm reduction and care. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 23:33-6. [PMID: 21705205 DOI: 10.1016/j.drugpo.2011.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 04/14/2011] [Accepted: 05/23/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Increasingly, patients receiving methadone treatment are found in low threshold facilities (LTF), which provide needle exchange programmes in Switzerland. This paper identifies the characteristics of LTF attendees receiving methadone treatment (MT) compared with other LTF attendees (non-MT). METHODS A national cross-sectional survey was conducted in 2006 over five consecutive days in all LTF (n=25). Attendees were given an anonymous questionnaire, collecting information on socio-demographic indicators, drug consumption, injection, methadone treatment, and self-reported HIV and HCV status. Univariate analysis and logistic regression were performed to compare MT to non-MT. The response rate was 66% (n=1128). RESULTS MT comprised 57.6% of the sample. In multivariate analysis, factors associated with being on MT were older age (OR: 1.38), being female (OR: 1.60), having one's own accommodation (OR: 1.56), receiving public assistance (OR: 2.29), lifetime injecting (OR: 2.26), HIV-positive status (OR: 2.00), and having consumed cocaine during the past month (OR: 1.37); MT were less likely to have consumed heroin in the past month (OR: 0.76, not significant) and visited LTF less often on a daily basis (OR: 0.59). The number of injections during the past week was not associated with MT. CONCLUSIONS More LTF attendees were in the MT group, bringing to light an underappreciated LTF clientele with specific needs. The MT group consumption profile may reflect therapeutic failure or deficits in treatment quality and it is necessary to acknowledge this and to strengthen the awareness of LTF personnel about potential needs of MT attendees to meet their therapeutic goals.
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Affiliation(s)
- Jean-Pierre Gervasoni
- Institute of Social and Preventive Medicine (IUMSP), University Hospital Center and University of Lausanne, Bugnon 17, CH-1005 Lausanne, Switzerland.
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Philbin MM, Zhang F. Exploring stakeholder perceptions of facilitators and barriers to accessing methadone maintenance clinics in Yunnan Province, China. AIDS Care 2011; 22:623-9. [PMID: 20229375 DOI: 10.1080/09540120903311490] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Injection drug use is an ongoing public health crisis in China and one of the largest contributors to the transmission of HIV/AIDS. Though the government has rapidly scaled up methadone maintenance treatment clinics, they have not been extensively evaluated to analyze factors influencing rates of attendance. We explored the facilitators and barriers to accessing methadone maintenance clinics in Kunming City, Yunnan Province, China. Using in-depth qualitative interviews conducted from February 2008 to June 2008 with 35 informants - injection drug users (IDUs) and key stakeholders - we explored factors that determine whether drug users decide to present at methadone clinics. Interviews were digitally recorded with consent, transcribed verbatim, and translated. Content analysis was conducted to identify themes which included general attitudes toward methadone treatment, barriers and challenges to access, and suggestions for improvement. Within these, topics included responses to methadone, its side effects, and fear of discrimination, loss of privacy, and police interference. Respondents also listed numerous suggestions for improvement including raising awareness of harm reduction both among drug users and the community, providing additional support in the form of psychological counseling, job training and behavioral therapy, and increasing communication between police, government, and public health officials. High rates of HIV infection among IDUs in China have prompted public health responses including the scale up of methadone maintenance clinics. Our results may inform policy strategists in implementing social-structural changes to create enabling environments that facilitate an increase in access to methadone clinics among IDUs in Kunming.
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Affiliation(s)
- Morgan M Philbin
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD, USA.
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18
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Kidorf M, King VL, Peirce J, Pierce J, Kolodner K, Brooner RK. Benefits of concurrent syringe exchange and substance abuse treatment participation. J Subst Abuse Treat 2011; 40:265-71. [PMID: 21255959 PMCID: PMC3056913 DOI: 10.1016/j.jsat.2010.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 11/11/2010] [Accepted: 11/22/2010] [Indexed: 11/16/2022]
Abstract
Participation in syringe exchange programs (SEPs) is associated with many individual and public health benefits but may have little impact on reducing drug use without concurrent treatment engagement. This study evaluated rates of drug use, other risk behaviors, and illegal activities in newly registered SEP participants (N = 240) enrolled versus not enrolled in substance abuse treatment over a 4-month observation window and examined the effect of days in treatment on these outcomes. After controlling for baseline differences, SEP registrants enrolled in treatment (n = 113) reported less days of opioid and cocaine use, injection drug use, illegal activities, and incarceration than those not enrolled in treatment (n = 127). For those enrolled in treatment, days of treatment was strongly correlated with each of these outcomes. These findings provide good evidence for a dose-response effect of treatment in syringe exchangers and suggest that substance abuse treatment significantly expands the harm reduction benefits of SEP participation.
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Affiliation(s)
- Michael Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, MD, USA.
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19
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The association between executive functioning and motivation to enter treatment among regular users of heroin and/or cocaine in Baltimore, MD. Addict Behav 2010; 35:717-20. [PMID: 20226598 DOI: 10.1016/j.addbeh.2010.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Revised: 11/23/2009] [Accepted: 02/16/2010] [Indexed: 11/21/2022]
Abstract
This study explored the association between readiness to enter treatment and performance on the Wisconsin Card Sorting Test (WCST), a measure of problem solving ability and executive functioning. Data for this analysis was collected on 258 current regular users of heroin and/or cocaine as part of an epidemiologic study on executive function and drug use. A structural equation model was used to test the hypotheses that poorer performance on the WCST would predict lower scores on two latent constructs measuring motivation to change drug use. Specifically, poorer performance on the WCST was associated with lower recognition of problem use. Associations between treatment enrollment within the past six months and regular use of more than one drug were also observed. Findings highlight the importance of considering cognitive impairment in programs targeting active drug users and promoting treatment participation.
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20
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Kidorf M, King VL, Neufeld K, Peirce J, Kolodner K, Brooner RK. Improving substance abuse treatment enrollment in community syringe exchangers. Addiction 2009; 104:786-95. [PMID: 19413790 DOI: 10.1111/j.1360-0443.2009.02560.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The present study evaluated the effectiveness of an intervention combining motivational enhancement and treatment readiness groups, with and without monetary incentives for attendance and treatment enrollment, on enhancing rates of substance abuse treatment entry among new registrants at the Baltimore Needle Exchange Program (BNEP). DESIGN Opioid-dependent study participants (n = 281) referred by the BNEP were assigned randomly to one of three referral interventions: (i) eight individual motivational enhancement sessions and 16 treatment readiness group sessions (motivated referral condition--MRC); (ii) the MRC intervention with monetary incentives for attending sessions and enrolling in treatment--MRC+I); or (iii) a standard referral condition which directed participants back to the BNEP for referral (standard referral-SRC). Participants were followed for 4 months. FINDINGS MRC+I participants were more likely to enroll in any type of treatment than MRC or SRC participants (52.1% versus 31.9% versus 35.5%; chi(2) = 9.12, P = 0.01), and more likely to enroll in treatment including methadone than MRC or SRC participants (40.4% versus 20.2% versus 16.1%; chi(2) = 16.65, P < 0.001). MRC+I participants also reported less heroin and injection use than MRC and SRC participants. CONCLUSIONS Syringe exchange sites can be effective platforms to motivate opioid users to enroll in substance abuse treatment and ultimately reduce drug use and number of drug injections.
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Affiliation(s)
- Michael Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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21
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Evans JL, Hahn JA, Lum PJ, Stein ES, Page K. Predictors of injection drug use cessation and relapse in a prospective cohort of young injection drug users in San Francisco, CA (UFO Study). Drug Alcohol Depend 2009; 101:152-7. [PMID: 19181458 PMCID: PMC2692897 DOI: 10.1016/j.drugalcdep.2008.12.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 11/20/2008] [Accepted: 12/03/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies of injection drug use cessation have largely sampled adults in drug treatment settings. Little is known about injection cessation and relapse among young injection drug users (IDU) in the community. METHODS A total of 365 HCV-negative IDU under age 30 years were recruited by street outreach and interviewed quarterly for a prospective cohort between January 2000 and February 2008. Participants were followed for a total of 638 person-years and 1996 visits. We used survival analysis techniques to identify correlates of injection cessation (> or =3 months) and relapse to injection. RESULTS 67% of subjects were male, median age was 22 years (interquartile range (IQR) 20-26) and median years injecting was 3.6 (IQR 1.3-6.5). 28.8% ceased injecting during the follow-up period. Among those that ceased injecting, nearly one-half resumed drug injection on subsequent visits, one-quarter maintained injecting cessation, and one-quarter were lost to follow-up. Participating in a drug treatment program in the last 3 months and injecting less than 30 times per month were associated with injection cessation. Injecting heroin or heroin mixed with other drugs, injecting the residue from previously used drug preparation equipment, drinking alcohol, and using benzodiazepines were negatively associated with cessation. Younger age was associated with relapse to injection. CONCLUSION These results suggest that factors associated with stopping injecting involve multiple areas of intervention, including access to drug treatment and behavioral approaches to reduce injection and sustain cessation. The higher incidence of relapse in the younger subjects in this cohort underscores the need for earlier detection and treatment programs targeted to adolescents and transition-age youth.
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Affiliation(s)
- Jennifer L. Evans
- Prevention and Public Health Group, Department of Epidemiology & Biostatistics, University of California, San Francisco, 50 Beale St, Suite 1200, San Francisco, CA 94105, USA, Corresponding author. Tel. +1 415 597 8133; fax +1 415 597 8299. E-mail address:
| | - Judith A. Hahn
- EPI Center, Department of Medicine, University of California, San Francisco, PO Box 1372, San Francisco, CA 94113, USA
| | - Paula J. Lum
- Positive Health Program, Department of Medicine, University of California, San Francisco, 995 Potrero Ave., Building 80, Ward 84, San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Ellen S. Stein
- Prevention and Public Health Group, Department of Epidemiology & Biostatistics, University of California, San Francisco, 50 Beale St, Suite 1200, San Francisco, CA 94105, USA
| | - Kimberly Page
- Prevention and Public Health Group, Department of Epidemiology & Biostatistics, University of California, San Francisco, 50 Beale St, Suite 1200, San Francisco, CA 94105, USA
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22
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Predictors of opiate agonist treatment retention among injection drug users referred from a needle exchange program. J Subst Abuse Treat 2009; 36:306-12. [DOI: 10.1016/j.jsat.2008.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 06/24/2008] [Accepted: 07/17/2008] [Indexed: 10/21/2022]
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23
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Philbin MM, Lozada R, Zúñiga ML, Mantsios A, Case P, Magis-Rodriguez C, Latkin CA, Strathdee SA. A qualitative assessment of stakeholder perceptions and socio-cultural influences on the acceptability of harm reduction programs in Tijuana, Mexico. Harm Reduct J 2008; 5:36. [PMID: 19021899 PMCID: PMC2613137 DOI: 10.1186/1477-7517-5-36] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 11/20/2008] [Indexed: 11/26/2022] Open
Abstract
Background The Mexico-U.S. border region is experiencing rising rates of blood-borne infections among injection drug users (IDUs), emphasizing the need for harm reduction interventions. Methods We assessed the religious and cultural factors affecting the acceptability and feasibility of three harm reduction interventions – Needle exchange programs (NEPs), syringe vending machines, and safer injection facilities (SIFs) – in Tijuana, Mexico. In-depth qualitative interviews were conducted with 40 community stakeholders to explore cultural and societal-related themes. Results Themes that emerged included Tijuana's location as a border city, family values, and culture as a mediator of social stigma and empathy towards IDUs. Perception of low levels of both awareness and socio-cultural readiness for harm reduction interventions was noted. Religious culture emerged as a theme, highlighting the important role religious leaders play in determining community responses to harm reduction and rehabilitation strategies for IDUs. The influence of religious culture on stakeholders' opinions concerning harm reduction interventions was evidenced by discussions of family and social values, stigma, and resulting policies. Conclusion Religion and politics were described as both a perceived benefit and deterrent, highlighting the need to further explore the overall influences of culture on the acceptability and implementation of harm reduction programs for drug users.
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Affiliation(s)
- Morgan M Philbin
- Division of International Health, School of Medicine, University of California San Diego, La Jolla, California, USA.
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24
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Philbin MM, Mantsios A, Lozada R, Case P, Pollini RA, Alvelais J, Latkin CA, Magis-Rodriguez C, Strathdee SA. Exploring stakeholder perceptions of acceptability and feasibility of needle exchange programmes, syringe vending machines and safer injection facilities in Tijuana, Mexico. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 20:329-35. [PMID: 18963906 DOI: 10.1016/j.drugpo.2008.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 08/14/2008] [Accepted: 09/08/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Injection drug use is a growing public health crisis along the U.S.-Mexican border and rising rates of blood-borne infections highlight the pressing need for harm reduction interventions. We explored the acceptability and feasibility of such interventions in Tijuana, a city adjacent to San Diego, California. METHODS Using in-depth qualitative interviews conducted from August 2006-March 2007 with 40 key stakeholders - pharmacists, legal professionals, health officials, religious officials, drug treatment providers, and law enforcement personnel - we explored the acceptability and feasibility of interventions to reduce drug-related harm in Tijuana, Mexico. Interviews were taped with consent, transcribed verbatim, and translated. Content analysis was conducted to identify themes which included barriers, structural limitations, and suggestions for implementation. RESULTS Topics included acceptance and feasibility of needle exchange programmes (NEPs), syringe vending machines, and safer injection facilities (SIFs), structural barriers and suggestions for implementation. Of these interventions, NEPs were deemed the most acceptable (75%); however, only half believed these could be feasibly implemented, citing barriers involving religion, police, and lack of political will, public awareness, and funding. CONCLUSIONS Increasing HIV infection rates among injection drug users in Tijuana have prompted interest in public health responses. Our results may assist policy strategists in implementing social-structural interventions that will help create enabling environments that facilitate the scale-up and implementation of harm reduction in Tijuana.
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Affiliation(s)
- Morgan M Philbin
- School of Medicine, University of California, San Diego, La Jolla, CA 92093-0622, USA
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25
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A comparison of 1-year substance abuse treatment outcomes in community syringe exchange participants versus other referrals. Drug Alcohol Depend 2008; 97:122-9. [PMID: 18486360 PMCID: PMC2601705 DOI: 10.1016/j.drugalcdep.2008.03.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 03/26/2008] [Accepted: 03/26/2008] [Indexed: 02/07/2023]
Abstract
This longitudinal cohort study of 324 consecutive admissions to methadone maintenance treatment between 08/1994 and 09/1997 compared 1-year outcomes of opioid-dependent patients referred from a syringe exchange program (SEP; n=81) versus other sources (n=243). All participants received stepped-based counseling. The Addiction Severity Index was completed upon admission. Treatment outcomes were assessed using weekly urine testing and days in treatment. GEE regression models were used to evaluate the association between baseline variables and treatment outcomes. SEP referrals were older, included more males and African Americans, reported greater unemployment and heavier heroin, cocaine, and injection drug use at admission. During treatment, SEP referrals used more opioids (OR 2.57; 95% CI 1.86-3.56) and cocaine (OR 2.77; 95% CI 1.93-3.95), and were less likely to complete 1 year (35%) compared to other referrals (56%; hazard ratio 1.88; 95% CI 1.35-2.62). Nevertheless, referral source was not significantly associated with outcome when adjusted for baseline characteristics. Greater baseline frequency of substance and injection drug use, and younger age were positively associated with ongoing opioid and cocaine use. African American race and baseline unemployment were also associated with ongoing cocaine use. Younger age and greater baseline cocaine use were associated with poorer retention at 1 year. The poorer treatment response of SEP referrals is likely due to higher baseline problem severity. Specialized interventions may be required to reduce drug use and improve retention in this population.
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Cao W, Treloar C. Comparison of needle and syringe programme attendees and non-attendees from a high drug-using area in Sydney, New South Wales. Drug Alcohol Rev 2007; 25:439-44. [PMID: 16939939 DOI: 10.1080/09595230600891282] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study was to compare demographic and drug use profiles of non-needle and syringe programmes (NSP) attendees with NSP attendees from the same geographic area. Two data sources were used. One was from an annual national survey of injecting drug users (IDU) at NSP and analysis was restricted to survey sites in Kings Cross and Kogarah in 2003 (NSP survey). The other was from a survey of IDU who do not use NSP as their primary source of injecting equipment within the same broad geographical region (Access survey). Of the total 264 survey participants, 102 had never attended a NSP (non-NSP attendees) and 162 had previous experience of NSP (NSP attendees). Compared with NSP attendees, non-NSP attendees were less likely to report severe drug problems and more likely to report lower prevalence of HIV, hepatitis B and hepatitis C infection. Nevertheless, about 20% of non-NSP attendees reported re-use of needles and syringes after someone else in the previous month. Compared to NSP attendees, a lower rate of usage of health services was reported by non-NSP attendees. Strategies to promote access to NSP and harm reduction services, including testing for blood-borne viruses, information provision and consideration of referral to treatment among non-NSP attendees are recommended.
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Affiliation(s)
- Wen Cao
- National Centre in HIV Social Research, University of New South Wales, Sydney, New South Wales, Australia.
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Durrah TL. Correlates of daily smoking among female arrestees in New York City and Los Angeles, 1997. Am J Public Health 2005; 95:1788-92. [PMID: 16186456 PMCID: PMC1449437 DOI: 10.2105/ajph.2004.056457] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES I sought to determine correlates of daily smoking among recently arrested women involved in the Drug Use Forecasting Program (DUF), many of whom are illicit drug users. Also, I compared smoking rates among DUF women, who were illicit drug users, with rates among women taking part in the Behavioral Risk Factor Surveillance System (BRFSS) survey, who do not have high levels of drug use, to determine if drug use accounts for heavy smoking. METHODS I compared daily smoking, illicit drug use, and selected demographic characteristics in 2 DUF cities: New York, with the highest rate of smoking among DUF cities in 1997, and Los Angeles, with the lowest. I also compared DUF and BRFSS daily smoking rates. RESULTS Although rates of illicit drug use were similar in New York and Los Angeles (69.7% and 61.8%, respectively), the daily smoking rate was higher in New York (90.9% vs 41.7%). DUF smoking rates were higher than BRFSS rates; both rates were higher than the general population (23%). CONCLUSIONS Illicit drug use does not, in all cases, explain high rates of daily smoking. Future efforts to shape tobacco-related public health policies in New York and elsewhere should involve collaboration with criminal justice transitional health programs.
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Affiliation(s)
- Tracy L Durrah
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 600 West 168th St, 4th Floor, New York, NY 10032, USA.
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28
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Treloar C, Cao W. Barriers to use of Needle and Syringe Programmes in a high drug use area of Sydney, New South Wales. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2005. [DOI: 10.1016/j.drugpo.2005.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Wu LT, Pilowsky DJ, Wechsberg WM, Schlenger WE. Injection drug use among stimulant users in a national sample. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2004; 30:61-83. [PMID: 15083554 PMCID: PMC1307508 DOI: 10.1081/ada-120029866] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study examined the correlates of injection drug use (IDU) in a community sample of psychostimulant users. Factors related to the cessation of illicit drug use and substance abuse service utilization were also determined among a subsample of stimulant users who reported IDU. METHOD The study sample consisted of 3408 lifetime psychostimulant users from the National Household Survey on Drug Abuse. Logistic regression procedures were used to estimate independent associations of correlates of IDU. RESULTS Approximately one in seven lifetime stimulant users reported IDU in their lifetime. Stimulant users with a lifetime history of IDU were more likely than those who did not inject to be African-American, not have received a high school diploma, have a history of multiple drug use, and report an onset of stimulant use before age 18. Among recent stimulant users, being aged 26 or older, using stimulants at least weekly, and getting drunk in the past year were associated with increased odds of recent IDU. Only one-half of all injection drug users reported having ever used substance abuse services. Cessation of illicit drug use among injectors with a history of stimulant use is common (44%). CONCLUSIONS Further studies should clarify the natural history of IDU among stimulant users, including the cessation of drug use without participating in substance abuse treatment services.
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Affiliation(s)
- Li-Tzy Wu
- Center for Risk Behavior and Mental Health Research, RTI International, P.G. Box 12194, Research Triangle Park, NC 27709-2194, USA.
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