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David AR, Sian CR, Gebel CM, Linas BP, Samet JH, Sprague Martinez LS, Muroff J, Bernstein JA, Assoumou SA. Barriers to accessing treatment for substance use after inpatient managed withdrawal (Detox): A qualitative study. J Subst Abuse Treat 2022; 142:108870. [PMID: 36084559 PMCID: PMC10084712 DOI: 10.1016/j.jsat.2022.108870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/19/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Access to and uptake of evidence-based treatment for substance use disorder, specifically opioid use disorder (OUD), are limited despite the high death toll from drug overdose in the United States in recent years. Patient perceived barriers to evidence-based treatment after completion of short-term inpatient medically managed withdrawal programs (detox) have not been well studied. The purpose of the current study is to elicit patients' perspectives on challenges to transition to treatment, including medications for OUD (MOUD), after detox and potential solutions. METHODS We conducted semi-structured interviews (N = 24) at a detox center (2018-2019) to explore patients' perspectives on obstacles to treatment. The study managed the data in NVivo and we used content analysis to identify themes. RESULTS Patients' characteristics included the following: 54 % male; mean age 37 years; self-identified as White 67 %, Black 13 %, Latinx 8 %, Native Hawaiian/Pacific Islander 4 %, and other 8 %; heroin use in the past 3 months 67 %; and ever injecting drugs 71 %. Patients identified the following barriers: 1) lack of continuity of care; 2) limited number of detox and residential treatment program beds; 3) unstable housing; and 4) lack of options when choosing a treatment pathway. Solutions proposed by participants included: 1) increase low-barrier access to community MOUD; 2) add case managers at the detox center to establish continuity of care after discharge; 3) increase assistance with housing; and 4) encourage patient participation in treatment decisions. CONCLUSIONS Patients identified lack of continuity of care, especially care coordination, as a major barrier to substance use treatment. Increasing treatment utilization, including MOUD, necessitates a multimodal approach to continuity of care, low-barrier access to MOUD, and support to address unstable housing. Patients want care that incorporates options and respect for. individualized preferences and needs.
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Affiliation(s)
- Allison R David
- Department of Medicine, Boston Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, United States of America.
| | - Carlos R Sian
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA 02118, United States of America.
| | - Christina M Gebel
- Boston University School of Public Health, 801 Massachusetts Ave., Crosstown Center, Boston, MA 02118, United States of America
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA 02118, United States of America; Boston University School of Public Health, 801 Massachusetts Ave., Crosstown Center, Boston, MA 02118, United States of America; Boston University School of Medicine, 801 Massachusetts Ave., Crosstown Center, 2(nd) Floor, Boston, MA 02118, United States of America.
| | - Jeffrey H Samet
- Department of Medicine, Boston Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, United States of America; Boston University School of Public Health, 801 Massachusetts Ave., Crosstown Center, Boston, MA 02118, United States of America.
| | - Linda S Sprague Martinez
- Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, United States of America.
| | - Jordana Muroff
- Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, United States of America.
| | - Judith A Bernstein
- Boston University School of Public Health, 801 Massachusetts Ave., Crosstown Center, Boston, MA 02118, United States of America.
| | - Sabrina A Assoumou
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA 02118, United States of America; Boston University School of Medicine, 801 Massachusetts Ave., Crosstown Center, 2(nd) Floor, Boston, MA 02118, United States of America.
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Assoumou SA, Paniagua SM, Gonzalez P, Wang J, Beckwith CG, White LF, Taylor JL, Coogan K, Samet JH, Linas BP. HIV Pre-exposure Prophylaxis and Buprenorphine at a Drug Detoxification Center During the Opioid Epidemic: Opportunities and Challenges. AIDS Behav 2021; 25:2591-2598. [PMID: 33751315 DOI: 10.1007/s10461-021-03220-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 01/27/2023]
Abstract
Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and buprenorphine decrease HIV acquisition. Between November, 2016 and July, 2017, we surveyed persons (N = 200) at a drug detoxification center to assess their interest in PrEP and in buprenorphine, and to examine factors associated with such interests. Over the previous 6 months, 58% (117/200) injected drugs, 87% (173/200) used opioids, 50% (85/171) had condomless sex. Only 22% (26/117) of persons who injected drugs were aware of PrEP, yet 74% (86/116) and 72% (84/116) were interested in oral or injectable PrEP, respectively. Thirty-eight percent (47/125) of persons not receiving buprenorphine or methadone expressed interest in buprenorphine. After multivariable adjustment, Latinx ethnicity was associated with interest in PrEP (aOR 3.80; 95% CI 1.37-10.53), while male gender (aOR 2.76; 95% CI 1.21-6.34) was associated with interest in buprenorphine. Opportunities exist to implement PrEP and buprenorphine within drug detoxification centers.Clinical trial registration NCT02869776. Clinicaltrials.gov https://clinicaltrials.gov/ct2/show/NCT02869776?term=Sabrina+Assoumou&cond=HIV+HCV&rank=1 .
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