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Pro G, Zaller N. Interaction effects in the association between methadone maintenance therapy and experiences of racial discrimination in U.S. healthcare settings. PLoS One 2020; 15:e0228755. [PMID: 32027723 PMCID: PMC7004348 DOI: 10.1371/journal.pone.0228755] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/22/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Disparities in methadone maintenance therapy (MMT) outcomes have received limited attention, but there are important negative outcomes associated with MMT that warrant investigation. Racial discrimination is common in healthcare settings and affects opioid use disorder (OUD) treatment and comorbidities. However, race/ethnicity alone may not fully explain experiences of discrimination. MMT remains highly stigmatized and may compound the effect of race/ethnicity on discrimination in healthcare settings. We sought to quantify differential associations between MMT and experiences of racial discrimination between racial/ethnic groups in a U.S. national sample. METHODS We used the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013) to identify a subset of individuals with a lifetime OUD who had ever used MMT (survey n = 766; weighted population n = 5,276,507). We used multivariable logistic regression to model past-year experience of racial discrimination in a healthcare setting. We included an interaction term between race/ethnicity and MMT status to identify the odds of discrimination (MMT vs. no MMT [referent]) within racial/ethnic groups. We used survey procedures with weights to account for the parent study's complex survey design. FINDINGS Twenty-two percent of our sample experienced racial discrimination in a healthcare setting in the past year. Discrimination was more common among those who had ever used MMT (x2 = 10.00, p = 0.001) and racial/ethnic minorities (x2 = 23.15, p<0.001). The interaction effect was much stronger than the main effects of race/ethnicity and MMT status. MMT status (versus no MMT) was positively associated with discrimination among Blacks (aOR = 3.93, 95% CI = 3.87-3.98, p<0.001), Whites (aOR = 2.25, 95% CI = 2.23-2.27, p<0.001), and Latino/Latinas (aOR = 1.59, 95% CI = 1.55-1.62, p<0.001). Among American Indian/Alaska Natives (AI/AN), those who had used MMT had over thirty times the odds of racial discrimination, compared to their non-MMT counterparts (aOR = 32.78, 95% CI = 31.16-34.48, p<0.001). CONCLUSION Race/ethnicity alone did not sufficiently account for racial discrimination in healthcare settings among those with a lifetime OUD. MMT status was strongly associated with racial discrimination among AI/AN. Our strong interaction effect is indicative of an additional barrier to health services utilization among AI/AN, which has important implications for OUD treatment outcomes and comorbidities. Health promotion programs aimed at increased adoption of MMT are promising, but should be considered in the context of racial/ethnic disparities, drug use and MMT stigma, and implicit biases in clinical settings.
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Affiliation(s)
- George Pro
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Nick Zaller
- University of Arkansas for Medical Sciences College of Public Health, Little Rock, Arkansas, United States of America
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Diversity in the Needs and Outcomes of Low-Threshold/High-Tolerance Methadone Maintenance Therapy Clients. CANADIAN JOURNAL OF ADDICTION 2017. [DOI: 10.1097/cxa.0000000000000002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Gilchrist G, Swan D, Shaw A, Keding A, Towers S, Craine N, Munro A, Hughes E, Parrott S, Mdege N, Strang J, Taylor A, Watson J. Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial. Health Technol Assess 2017; 21:1-312. [PMID: 29208190 PMCID: PMC5733383 DOI: 10.3310/hta21720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Opioid substitution therapy and needle exchanges have reduced blood-borne viruses (BBVs) among people who inject drugs (PWID). Some PWID continue to share injecting equipment. OBJECTIVES To develop an evidence-based psychosocial intervention to reduce BBV risk behaviours and increase transmission knowledge among PWID, and conduct a feasibility trial among PWID comparing the intervention with a control. DESIGN A pragmatic, two-armed randomised controlled, open feasibility trial. Service users were Steering Group members and co-developed the intervention. Peer educators co-delivered the intervention in London. SETTING NHS or third-sector drug treatment or needle exchanges in Glasgow, London, Wrexham and York, recruiting January and February 2016. PARTICIPANTS Current PWID, aged ≥ 18 years. INTERVENTIONS A remote, web-based computer randomisation system allocated participants to a three-session, manualised, psychosocial, gender-specific group intervention delivered by trained facilitators and BBV transmission information booklet plus treatment as usual (TAU) (intervention), or information booklet plus TAU (control). MAIN OUTCOME MEASURES Recruitment, retention and follow-up rates measured feasibility. Feedback questionnaires, focus groups with participants who attended at least one intervention session and facilitators assessed the intervention's acceptability. RESULTS A systematic review of what works to reduce BBV risk behaviours among PWID; in-depth interviews with PWID; and stakeholder and expert consultation informed the intervention. Sessions covered improving injecting technique and good vein care; planning for risky situations; and understanding BBV transmission. Fifty-six per cent (99/176) of eligible PWID were randomised: 52 to the intervention group and 47 to the control group. Only 24% (8/34) of male and 11% (2/18) of female participants attended all three intervention sessions. Overall, 50% (17/34) of men and 33% (6/18) of women randomised to the intervention group and 47% (14/30) of men and 53% (9/17) of women randomised to the control group were followed up 1 month post intervention. Variations were reported by location. The intervention was acceptable to both participants and facilitators. At 1 month post intervention, no increase in injecting in 'risky' sites (e.g. groin, neck) was reported by participants who attended at least one session. PWID who attended at least one session showed a trend towards greater reduction in injecting risk behaviours, a greater increase in withdrawal planning and were more confident about finding a vein. A mean cost of £58.17 per participant was calculated for those attending one session, £148.54 for those attending two sessions and £270.67 for those attending all three sessions, compared with £0.86 in the control group. Treatment costs across the centres vary as a result of the different levels of attendance, as total session costs are divided by attendees to obtain a cost per attendee. The economic analysis suggests that a cost-effectiveness study would be feasible given the response rates and completeness of data. However, we have identified aspects where the service use questionnaire could be abbreviated given the low numbers reported in several care domains. No adverse events were reported. CONCLUSIONS As only 19% of participants attended all three intervention sessions and 47% were followed up 1 month post intervention, a future definitive randomised controlled trial of the intervention is not feasible. Exposure to information on improving injecting techniques did not encourage riskier injecting practices or injecting frequency, and benefits were reported among attendees. The intervention has the potential to positively influence BBV prevention. Harm reduction services should ensure that the intervention content is routinely delivered to PWID to improve vein care and prevent BBVs. FUTURE WORK The intervention did not meet the complex needs of some PWID, more tailoring may be needed to reach PWID who are more frequent injectors, who are homeless and female. LIMITATIONS Intervention delivery proved more feasible in London than other locations. Non-attendance at the York trial site substantially influenced the results. TRIAL REGISTRATION Current Controlled Trials ISRCTN66453696 and PROSPERO 014:CRD42014012969. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 72. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Davina Swan
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - April Shaw
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | - Sarah Towers
- Betsi Cadwaladr University Health Board, Bangor, UK
| | - Noel Craine
- Public Health Wales, Microbiology, Bangor, UK
| | - Alison Munro
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK
| | - Elizabeth Hughes
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Noreen Mdege
- Department of Health Sciences, University of York, York, UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Avril Taylor
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK
| | - Judith Watson
- Department of Health Sciences, University of York, York, UK
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Sarid O, Isralowitz R, Yehudai M, Reznik A. Suicidal Ideation Among Heroin-Abusing Mothers in Methadone Maintenance Treatment. CRISIS 2016; 37:461-464. [PMID: 27733062 DOI: 10.1027/0227-5910/a000429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a dearth of information about mothers in methadone maintenance treatment (MMT), their parental stress, and suicidal ideation. AIM To evaluate parenting stress and suicidal ideation among heroin-dependent mothers in MMT. METHOD The study was conducted at an MMT center. Inclusion criteria were mothers with at least one child between 6-12 years of age. Mothers (n = 41) were interviewed about their background characteristics, drug use, parenting stress, and suicide ideation. RESULTS The mothers' median age was 44 (27-63 years), 35% were single, 20% married or with a partner, 45% separated or divorced, 83% were Jewish, and about one-third completed elementary school only. Among the study participants, 52% reported ever thinking about suicide, 28% reported past-year ideation, and 15% indicated they were likely to complete suicide someday. Mothers who have used heroin and cannabis reported high levels of parenting stress. Mothers with high parenting stress levels were more likely to report suicidal ideation. Country of origin status did not differentiate those interviewed. CONCLUSION This study provides insight into a hard-to-reach population of mothers needing treatment, parental skills training, and mental stress reduction. Further research is needed to generalize the findings for treatment, education, and training purposes.
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Affiliation(s)
- Orly Sarid
- 1 Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Richard Isralowitz
- 1 Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel.,2 Regional Alcohol and Drug Abuse Research Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Mor Yehudai
- 1 Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Reznik
- 1 Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel.,2 Regional Alcohol and Drug Abuse Research Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Drumm RD, McBride D, Metsch L, Neufeld M, Sawatsky A. “I'm a Health Nut!” Street Drug Users' Accounts of Self-Care Strategies. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260503500311] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative study analyzes data from in-depth interviews to describe self-care strategies among chronic and injecting drug users. While the types of strategies varied from participant to participant, the theme of proactive self-care remained strong throughout the data. Researchers identified five self-care domains discussed by the study participants. The self-care domains include strategies to improve nutrition, increase physical activity, address medical concerns, regulate substance use, and reduce sexual risk. Overall, these data indicate that chronic drug users are actively involved in managing and improving their health and attempt to take self-protective actions, even while continuing to engage in active drug use. These findings are particularly relevant for primary care providers, walk-in clinics, drug treatment programs, outreach workers and those engaged in harm reduction efforts. Recognizing that drug users are actively involved in taking care of their health can be an important strategy to build into any intervention or risk reduction program.
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Affiliation(s)
- Rene‘ D. Drumm
- Professor and chair of the social work and family studies program at Southern Adventist University in Collegedale, Tennessee
| | - Duane McBride
- Director of the Andrews University's Institute for the Prevention of Addictions and director of the Drug Policy Research Component of ImpacTeen – a research partnership supported by the Robert Wood Johnson Foundation
| | - Lisa Metsch
- Associate professor of epidemiology and public health and the director of the sociomedical sciences research group at the University of Miami School of Medicine
| | - Melodie Neufeld
- Master of Social Work and Master of Divinity candidate at Andrews University and Associated Mennonite Biblical Seminary
| | - Alex Sawatsky
- Employed as a team leader for an Assertive Community Treatment Team in Elkhart, IN
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Corsi KF, Kwiatkowski CF, Booth RE. Long-Term Predictors of HIV Risk Behaviors among IDUs. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260603600307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drug users are at high risk for disease due to injection and sex behaviors. Longitudinal research with drug users can help researchers understand reasons for continued high-risk behaviors among this vulnerable population. Data are from a follow-up study conducted from 1999 to 2003, which attempted to relocate clients who were initially recruited through street outreach in Denver, Colorado from 1990 to 1995. A total of 773 subjects were located (82% relocation rate), 578 of whom were interviewed at follow-up. Statistical analysis revealed significant improvement in most high-risk injection and sex behaviors. However, over half the sample reported having sex without a condom at follow-up. Further analysis revealed that having sex without a condom at baseline, not having previously participated in drug treatment, being of an ethnicity other than African American, smoking crack, and having sex with a drug injector were all significantly related to having sex without a condom at follow-up. These findings are discussed with regards to developing interventions in order to increase condom use in this high risk population.
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Isralowitz R, Reznik A, Pruginin I. Quality of life among former Soviet Union and Israeli origin methadone users. J Ethn Subst Abuse 2015; 15:425-433. [PMID: 26440797 DOI: 10.1080/15332640.2015.1046009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A common treatment intervention for heroin addiction is methadone maintenance. In recent years a wider perspective has been adapted to understand and evaluate addiction through quality of life. This article examines quality of life conditions of 170 male former Soviet Union and Israeli origin drug users in methadone maintenance and provides an understanding of conditions linked to the World Health Organization Quality of Life project's best available techniques reference document. Having a partner or spouse and less chronic illness are positive factors affecting quality of life regardless of country of origin. Israeli born drug users reported better quality of life based on their psychological health and environment domain responses; no difference was found for the physical health and social relationship domains of the Israeli and former Soviet Union origin males. Because heroin addiction is a chronic and relapsing illness, one of the goals of methadone maintenance is to address patients' health status from a broad perspective. Based on clinical observations, the treatment of special populations may be enhanced if their particular needs are considered and met. Quality of life factors are relevant for assessing high risk groups, including those from different ethnic origins, in poor physical and psychological health, their treatment and personal adjustment, and their service personnel training needs.
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Affiliation(s)
- Richard Isralowitz
- a Regional Alcohol and Drug Abuse Research Center, Spitzer Department of Social Work , Ben Gurion University , Beer Sheva , Israel
| | - Alexander Reznik
- a Regional Alcohol and Drug Abuse Research Center, Spitzer Department of Social Work , Ben Gurion University , Beer Sheva , Israel
| | - Itay Pruginin
- a Regional Alcohol and Drug Abuse Research Center, Spitzer Department of Social Work , Ben Gurion University , Beer Sheva , Israel
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Bachireddy C, Soule MC, Izenberg JM, Dvoryak S, Dumchev K, Altice FL. Integration of health services improves multiple healthcare outcomes among HIV-infected people who inject drugs in Ukraine. Drug Alcohol Depend 2014; 134:106-114. [PMID: 24128379 PMCID: PMC3865106 DOI: 10.1016/j.drugalcdep.2013.09.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND People who inject drugs (PWID) experience poor outcomes and fuel HIV epidemics in middle-income countries in Eastern Europe and Central Asia. We assess integrated/co-located (ICL) healthcare for HIV-infected PWID, which despite international recommendations, is neither widely available nor empirically examined. METHODS A 2010 cross-sectional study randomly sampled 296 HIV-infected opioid-dependent PWID from two representative HIV-endemic regions in Ukraine where ICL, non-co-located (NCL) and harm reduction/outreach (HRO) settings are available. ICL settings provide onsite HIV, addiction, and tuberculosis services, NCLs only treat addiction, and HROs provide counseling, needles/syringes, and referrals, but no opioid substitution therapy (OST). The primary outcome was receipt of quality healthcare, measured using a quality healthcare indicator (QHI) composite score representing percentage of eight guidelines-based recommended indicators met for HIV, addiction and tuberculosis treatment. The secondary outcomes were individual QHIs and health-related quality-of-life (HRQoL). RESULTS On average, ICL-participants had significantly higher QHI composite scores compared to NCL- and HRO-participants (71.9% versus 54.8% versus 37.0%, p<0.001) even after controlling for potential confounders. Compared to NCL-participants, ICL-participants were significantly more likely to receive antiretroviral therapy (49.5% versus 19.2%, p<0.001), especially if CD4 ≤ 200 (93.8% versus 62.5% p<0.05); guideline-recommended OST dosage (57.3% versus 41.4%, p<0.05); and isoniazid preventive therapy (42.3% versus 11.2%, p<0.001). Subjects receiving OST had significantly higher HRQoL than those not receiving it (p<0.001); however, HRQoL did not differ significantly between ICL- and NCL-participants. CONCLUSIONS These findings suggest that OST alone improves quality-of-life, while receiving care in integrated settings collectively and individually improves healthcare quality indicators for PWID.
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Affiliation(s)
- Chethan Bachireddy
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, USA
| | - Michael C. Soule
- Massachussetts General Hospital, Department of Psychiatry, Boston, USA
| | - Jacob M. Izenberg
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, USA
| | - Sergey Dvoryak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | | | - Frederick L. Altice
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, USA,Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, USA
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Timko C, Bonn-Miller MO, McKellar J, Ilgen M. Detoxification History and 2-Year Outcomes of Substance Use Disorder Treatment and Mutual-Help Group Participation. JOURNAL OF DRUG ISSUES 2013. [DOI: 10.1177/0022042613491102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about detoxification (detox) history as a risk factor for poor treatment outcomes among dually diagnosed (substance use and other mental health disorders) patients. We compared patients with a detox history with those who had never received detox on baseline characteristics, subsequent treatment and mutual-help group participation, and substance use and related outcomes at 6-month, 1-year, and 2-year follow-ups. Having a detox history was associated with poorer status at treatment intake, but detoxed patients were functioning as well as never-detoxed patients on alcohol and drug use severity 2 years later. However, having a detox history at baseline was associated with poorer psychological and legal functioning at follow-ups. Assessing detox history in mental health programs would be feasible to implement routinely. Targeting more comprehensive mental health, case management, and 12-step facilitation services to dually diagnosed patients with a history of detox may improve mental health and criminal involvement status.
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Affiliation(s)
- Christine Timko
- Department of Veterans Affairs Health Care System, Palo Alto, CA, USA
- Stanford University Medical Center, Palo Alto, CA
| | - Marcel O. Bonn-Miller
- Department of Veterans Affairs Health Care System, Palo Alto, CA, USA
- Stanford University Medical Center, Palo Alto, CA
- Department of Veterans Affairs Center of Excellence in Substance Abuse Treatment and Education, Philadelphia, PA, USA
| | - John McKellar
- Department of Veterans Affairs Health Care System, Palo Alto, CA, USA
- Stanford University Medical Center, Palo Alto, CA
- Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Mark Ilgen
- Department of Veterans Affairs Health Care System, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
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Gowing L, Farrell MF, Bornemann R, Sullivan LE, Ali R. Oral substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev 2011:CD004145. [PMID: 21833948 DOI: 10.1002/14651858.cd004145.pub4] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Injecting drug users are vulnerable to infection with Human Immunodeficiency Virus (HIV) and other blood borne viruses as a result of collective use of injecting equipment as well as sexual behaviour OBJECTIVES To assess the effect of oral substitution treatment for opioid dependent injecting drug users on risk behaviours and rates of HIV infections SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and PsycINFO to May 2011. We also searched reference lists of articles, reviews and conference abstracts SELECTION CRITERIA Studies were required to consider the incidence of risk behaviours, or the incidence of HIV infection related to substitution treatment of opioid dependence. All types of original studies were considered. Two authors independently assessed each study for inclusion DATA COLLECTION AND ANALYSIS Two authors independently extracted key information from each of the included studies. Any differences were resolved by discussion or by referral to a third author. MAIN RESULTS Thirty-eight studies, involving some 12,400 participants, were included. The majority were descriptive studies, or randomisation processes did not relate to the data extracted, and most studies were judged to be at high risk of bias. Studies consistently show that oral substitution treatment for opioid-dependent injecting drug users with methadone or buprenorphine is associated with statistically significant reductions in illicit opioid use, injecting use and sharing of injecting equipment. It is also associated with reductions in the proportion of injecting drug users reporting multiple sex partners or exchanges of sex for drugs or money, but has little effect on condom use. It appears that the reductions in risk behaviours related to drug use do translate into reductions in cases of HIV infection. However, because of the high risk of bias and variability in several aspects of the studies, combined totals were not calculated. AUTHORS' CONCLUSIONS Oral substitution treatment for injecting opioid users reduces drug-related behaviours with a high risk of HIV transmission, but has less effect on sex-related risk behaviours. The lack of data from randomised controlled studies limits the strength of the evidence presented in this review.
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Affiliation(s)
- Linda Gowing
- Discipline of Pharmacology, University of Adelaide, Frome Road, Adelaide, South Australia, Australia, 5005
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Plater-Zyberk CJ, Varenbut M, Daiter J, Worster A. The Value of Clinical Case Management in a Methadone Maintenance Treatment Program. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 38:70-2. [DOI: 10.3109/00952990.2011.600391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Jeff Daiter
- Ontario Addiction Treatment Centres,
Richmond Hill, ON, Canada
| | - Andrew Worster
- Ontario Addiction Treatment Centres,
Richmond Hill, ON, Canada
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Booth RE, Campbell BK, Mikulich-Gilbertson SK, J. Tillotson C, Choi D, Robinson J, Calsyn DA, Mandler RN, Jenkins LM, Thompson LL, Dempsey CL, Liepman MR, McCarty D. Reducing HIV-related risk behaviors among injection drug users in residential detoxification. AIDS Behav 2011; 15:30-44. [PMID: 20652630 DOI: 10.1007/s10461-010-9751-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study of 632 drug injectors enrolled in eight residential detoxification centers within the National Drug Abuse Treatment Clinical Trials Network tested three interventions to reduce drug and sex risk behaviors. Participants were randomized to: (a) a two-session, HIV/HCV counseling and education (C&E) model added to treatment as usual (TAU), (b) a one-session, therapeutic alliance (TA) intervention conducted by outpatient counselors to facilitate treatment entry plus TAU, or (c) TAU. Significant reductions in drug and sex risk behaviors occurred for all three conditions over a 6-month follow-up period. C&E participants reported significantly greater rates of attending an HIV testing appointment, but this was not associated with better risk reduction outcomes. Reporting treatment participation within 2 months after detoxification and self-efficacy to practice safer injection behavior predicted reductions in injection risk behaviors. Findings indicate that participation in detoxification was followed by significant decreases in drug injection and risk behaviors for up to 6-months; interventions added to standard treatment offered no improvement in risk behavior outcomes.
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Kelly SM, Schwartz RP, O'Grady KE, Mitchell SG, Reisinger HS, Peterson JA, Agar MH, Brown BS. Gender Differences Among In- and Out-of-Treatment Opioid-Addicted Individuals. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 35:38-42. [PMID: 19152205 DOI: 10.1080/00952990802342915] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Gender differences were explored among 355 in- and out-of-treatment opioid-addicted adults in Baltimore. METHODS Addiction Severity Index and other variables were compared among: 1) in-treatment women vs. out-of-treatment women; 2) out-of-treatment: women vs. men; and, 3) in-treatment: women vs. men. RESULTS Analysis indicated that in-treatment and out-of-treatment women worked less and used more cocaine than their male counterparts (ps < .01). Moreover, out-of-treatment women used heroin and cocaine more often, spent more money on drugs, earned more illegal income, and had fewer treatments than in-treatment women (ps < or = .01). CONCLUSIONS Findings indicate greater severity of drug and employment problems of opioid-addicted women and underline the need for gender-specific drug-treatment services.
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Affiliation(s)
- Sharon M Kelly
- Social Research Center, Friends Research Institute, Inc., Baltimore, Maryland, USA.
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Corsi KF, Lehman WK, Booth RE. The effect of methadone maintenance on positive outcomes for opiate injection drug users. J Subst Abuse Treat 2009; 37:120-6. [PMID: 19150202 DOI: 10.1016/j.jsat.2008.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 09/25/2008] [Accepted: 11/24/2008] [Indexed: 10/21/2022]
Abstract
This study examined outcome variables for 160 opiate injection drug users (IDUs) who entered methadone maintenance between baseline and 6-month follow-up. Outcome variables of interest included drug use, productivity, and HIV risk behaviors. Participants were recruited through street outreach in Denver, CO, from 2000 through 2004 using targeted sampling. The sample was primarily men, White (48%), averaged 39 years of age, and had been injecting drugs for an average of nearly 20 years. Significant improvements were found in univariate tests. Logistic regression revealed that spending more time in treatment was a significant predictor of positive outcomes on drug use and HIV risk behaviors. The results underscore the importance of retaining IDUs in methadone maintenance to maximize their treatment success. Results from this study show that time in treatment can affect many aspects of the participant's life in a positive way, including reduction of HIV risk.
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Affiliation(s)
- Karen F Corsi
- Department of Psychiatry, University of Colorado Denver School of Medicine, Denver, CO, USA.
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Palepu A, Tyndall MW, Joy R, Kerr T, Wood E, Press N, Hogg RS, Montaner JSG. Antiretroviral adherence and HIV treatment outcomes among HIV/HCV co-infected injection drug users: the role of methadone maintenance therapy. Drug Alcohol Depend 2006; 84:188-94. [PMID: 16542797 DOI: 10.1016/j.drugalcdep.2006.02.003] [Citation(s) in RCA: 175] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Revised: 02/05/2006] [Accepted: 02/07/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We examined the association of methadone maintenance therapy (MMT) with highly active antiretroviral therapy (HAART) adherence and HIV treatment outcomes among a cohort of HIV/HCV co-infected injection drug users (IDUs). METHODS We obtained demographic, drug use, and addiction care history from the Vancouver Injection Drug User Study (VIDUS), which is an open cohort study of IDUs. The questionnaires were longitudinally linked to the British Columbia HIV/AIDS Drug Treatment Program to obtain HAART adherence and HIV treatment outcome data. There were 278 VIDUS participants who accessed HAART from August 1, 1996 to November 24, 2003. We constructed longitudinal logistic models using generalized estimating equations to examine the independent associations between methadone maintenance therapy and the following outcomes: HAART adherence; plasma HIV-1 RNA suppression; and CD4 cell rise of 100cells/mm(3). RESULTS Among participants who reported at least weekly heroin use, MMT was independently associated with lower odds of subsequent weekly heroin use during the follow-up period (adjusted odds ratio; 95% confidence interval [AOR; 95% CI]: 0.24; 0.14-0.40). We also found that MMT was positively associated with adherence (AOR 1.52; 95% CI 1.16-2.00), HIV-1 RNA suppression (AOR 1.34; 95% CI 1.00-1.79), and CD4 cell count rise (AOR 1.58; 95% CI 1.26-1.99). CONCLUSIONS Among HIV/HCV co-infected IDUs on HAART, enrollment in MMT was associated with reduced heroin use, and improved adherence, HIV-1 RNA suppression and CD4 cell count response. Integrating opiate addiction care and HIV care may provide improved health outcomes for this vulnerable population and should be further explored.
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Affiliation(s)
- Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, University of British Columbia, BC, Canada.
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Booth RE, Corsi KF, Mikulich-Gilbertson SK. Factors associated with methadone maintenance treatment retention among street-recruited injection drug users. Drug Alcohol Depend 2004; 74:177-85. [PMID: 15099661 DOI: 10.1016/j.drugalcdep.2003.12.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2003] [Revised: 12/04/2003] [Accepted: 12/05/2003] [Indexed: 11/28/2022]
Abstract
This study examined factors associated with methadone maintenance retention, defined as remaining in treatment for a minimum of 90 days, among street recruited injection drug users (IDUs). Targeted sampling methods were used to establish recruitment quotas in Denver census tracks. A total of 577 IDUs were randomly assigned to either a risk reduction intervention, focusing on safer injection and sex behaviors, or motivational interviewing, addressing more sweeping lifestyle changes including drug treatment. All subjects who wanted treatment were provided transportation, rapid intake and a waiver of the intake fee. In addition, 50% were randomly assigned a coupon for 90 days of free treatment. Overall, 33% entered treatment and of these, 60% remained for at least 90 days. Factors associated with retention included higher methadone dose, free treatment, greater contacts with the clinic and counselor rating of patient cooperation. Although desire for treatment, or motivation, was associated in univariate analyses with greater retention, there were no differences observed between the motivational interviewing and risk reduction interventions.
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Affiliation(s)
- Robert E Booth
- Department of Psychiatry, School of Medicine, University of Colorado Health Sciences Center, 1741 Vine Street, Denver, CO 80206, USA.
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Booth RE, Corsi KF, Mikulich SK. Improving entry to methadone maintenance among out-of-treatment injection drug users. J Subst Abuse Treat 2003; 24:305-11. [PMID: 12867204 DOI: 10.1016/s0740-5472(03)00038-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study of 577 out-of-treatment drug injectors was designed to assess predictors of methadone maintenance treatment entry, including offering free treatment coupons. Using targeted sampling methods, participants were recruited through street outreach; randomly, they were either assigned a coupon for 90 days of free treatment or required to pay for their treatment. Regardless of assignment, all subjects who desired treatment were provided transportation, rapid intake, and a waiver of the treatment entry fee. Overall, 33% entered treatment, including 66% of those who received a free coupon. Other factors associated with treatment entry included desire for treatment, heroin use, prior treatment experience, associating with fewer drug-using friends, and injecting with a previously used unsterile needle/syringe. Injecting cocaine and smoking crack reduced the probability of treatment entry. Findings lend support to street outreach efforts designed to increase rates of treatment entry among chronic out-of-treatment drug injectors. Additional treatment options are required for those abusing cocaine.
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Affiliation(s)
- Robert E Booth
- University of Colorado Health Sciences Center, School of Medicine, Department of Psychiatry, 80206, Denver, CO, USA.
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