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Fox AD, Riback L, Perez-Correa A, Ohlendorf E, Ghiroli M, Behrends CN, López-Castro T. High Interest in Injectable Opioid Agonist Treatment With Hydromorphone Among Urban Syringe Service Program Participants. Subst Use Addctn J 2024; 45:44-53. [PMID: 38258851 DOI: 10.1177/29767342231210552] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Injectable opioid agonist treatment with hydromorphone (iOAT-H) is effective for persons who inject drugs (PWID) with opioid use disorder (OUD) but remains unavailable in the United States. Our objective was to determine interest in iOAT-H among syringe services program (SSP) participants. METHODS We recruited PWID with OUD from SSPs in New York City. Interest in iOAT-H was assessed on a 4-point scale. We compared participants who were and were not interested in iOAT-H regarding sociodemographic characteristics and self-reported variables (past 30 days): heroin use, public injection practices, and participation in illegal activity other than drug possession. Participants reported their preferred OUD treatment and reasons for these preferences. RESULTS Of 108 participants, most were male (69%), Hispanic (68%), and median age was 42 years. The median number of prior OUD treatment episodes was 6 (interquartile range: 2-12). Most (65%) were interested in iOAT-H. Interested participants (vs not interested) reported, over the prior 30 days, greater heroin use days (mean, 26.4 vs 22.3), injecting in public more times (median, 15 vs 6), and a higher percentage having participated in illegal activity (40% vs 16%). Preferences for OUD treatment were: iOAT-H (43%), methadone (39%), and buprenorphine (9%). Participants who preferred iOAT-H to conventional OUD treatments reported preferring injection as a route of administration and that available OUD treatments helped them insufficiently. CONCLUSIONS SSP participants with OUD reported high interest in iOAT-H. Participants had attempted conventional treatments but still used heroin almost daily. We identified PWID at risk for opioid-related harms who potentially could benefit from iOAT-H.
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Affiliation(s)
- Aaron D Fox
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | - Lindsey Riback
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | - Andres Perez-Correa
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | | | - Megan Ghiroli
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
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Jakubowski A, Rath C, Harocopos A, Wright M, Welch A, Kattan J, Navos Behrends C, Lopez-Castro T, Fox AD. Implementation of buprenorphine services in NYC syringe services programs: a qualitative process evaluation. Harm Reduct J 2022; 19:75. [PMID: 35818071 PMCID: PMC9275037 DOI: 10.1186/s12954-022-00654-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/22/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Syringe services programs (SSPs) hold promise for providing buprenorphine treatment access to people with opioid use disorder (OUD) who are reluctant to seek care elsewhere. In 2017, the New York City Department of Health and Mental Hygiene (DOHMH) provided funding and technical assistance to nine SSPs to develop "low-threshold" buprenorphine services as part of a multipronged initiative to lower opioid-related overdose rates. The aim of this study was to identify barriers to and facilitators of implementing SSP-based buprenorphine services. METHODS We conducted 26 semi-structured qualitative interviews from April 2019 to November 2019 at eight SSPs in NYC that received funding and technical assistance from DOHMH. Interviews were conducted with three categories of staff: leadership (i.e., buprenorphine program management or leadership, eight interviews), staff (i.e., buprenorphine coordinators or other staff, eleven interviews), and buprenorphine providers (six interviews). We identified themes related to barriers and facilitators to program implementation using thematic analysis. We make recommendations for implementation based on our findings. RESULTS Programs differed in their stage of development, location of services provided, and provider type, availability, and practices. Barriers to providing buprenorphine services at SSPs included gaps in staff knowledge and comfort communicating with participants about buprenorphine, difficulty hiring buprenorphine providers, managing tension between harm reduction and traditional OUD treatment philosophies, and financial constraints. Challenges also arose from serving a population with unmet psychosocial needs. Implementation facilitators included technical assistance from DOHMH, designated buprenorphine coordinators, offering other supportive services to participants, and telehealth to bridge gaps in provider availability. Key recommendations include: (1) health departments should provide support for SSPs in training staff, building health service infrastructure and developing policies and procedures, (2) SSPs should designate a buprenorphine coordinator and ensure regular training on buprenorphine for frontline staff, and (3) buprenorphine providers should be selected or supported to use a harm reduction approach to buprenorphine treatment. CONCLUSIONS Despite encountering challenges, SSPs implemented buprenorphine services outside of conventional OUD treatment settings. Our findings have implications for health departments, SSPs, and other community organizations implementing buprenorphine services. Expansion of low-threshold buprenorphine services is a promising strategy to address the opioid overdose epidemic.
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Affiliation(s)
- Andrea Jakubowski
- Division of General Internal Medicine, Department of Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY, 10467, USA.
| | - Caroline Rath
- grid.238477.d0000 0001 0320 6731Bureau of Alcohol, Drug Use, Care, Prevention and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th Street Queens, Long Island City, NY 11101 USA
| | - Alex Harocopos
- grid.238477.d0000 0001 0320 6731Bureau of Alcohol, Drug Use, Care, Prevention and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th Street Queens, Long Island City, NY 11101 USA
| | - Monique Wright
- grid.238477.d0000 0001 0320 6731Bureau of Alcohol, Drug Use, Care, Prevention and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th Street Queens, Long Island City, NY 11101 USA
| | - Alice Welch
- grid.238477.d0000 0001 0320 6731Bureau of Alcohol, Drug Use, Care, Prevention and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th Street Queens, Long Island City, NY 11101 USA
| | - Jessica Kattan
- grid.238477.d0000 0001 0320 6731Bureau of Alcohol, Drug Use, Care, Prevention and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th Street Queens, Long Island City, NY 11101 USA
| | - Czarina Navos Behrends
- grid.5386.8000000041936877XDepartment of Population Health Sciences, Weill Cornell Medical College, 402 E. 67th St, New York, NY 10065 USA
| | - Teresa Lopez-Castro
- grid.254250.40000 0001 2264 7145Department of Psychology, The City College of New York, 160 Convent Avenue, New York, NY 10031 USA
| | - Aaron D. Fox
- grid.251993.50000000121791997Division of General Internal Medicine, Department of Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY 10467 USA
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Quan AML, Mah C, Krebs E, Zang X, Chen S, Althoff K, Armstrong W, Behrends CN, Dombrowski JC, Enns E, Feaster DJ, Gebo KA, Goedel WC, Golden M, Marshall BDL, Mehta SH, Pandya A, Schackman BR, Strathdee SA, Sullivan P, Tookes H, Nosyk B. Improving health equity and ending the HIV epidemic in the USA: a distributional cost-effectiveness analysis in six cities. Lancet HIV 2021; 8:e581-e590. [PMID: 34370977 PMCID: PMC8423356 DOI: 10.1016/s2352-3018(21)00147-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the USA, Black and Hispanic or Latinx individuals continue to be disproportionately affected by HIV. Applying a distributional cost-effectiveness framework, we estimated the cost-effectiveness and epidemiological impact of two combination implementation approaches to identify the approach that best meets the dual objectives of improving population health and reducing racial or ethnic health disparities. METHODS We adapted a dynamic, compartmental HIV transmission model to characterise HIV micro-epidemics in six US cities: Atlanta, Baltimore, Los Angeles, Miami, New York, and Seattle. We considered combinations of 16 evidence-based interventions to diagnose, treat, and prevent HIV transmission according to previously documented levels of scale-up. We then identified optimal combination strategies for each city, with the distribution of each intervention implemented according to existing service levels (proportional services approach) and the racial or ethnic distribution of new diagnoses (between Black, Hispanic or Latinx, and White or other ethnicity individuals; equity approach). We estimated total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios of strategies implemented from 2020 to 2030 (health-care perspective; 20-year time horizon; 3% annual discount rate). We estimated three measures of health inequality (between-group variance, index of disparity, Theil index), incidence rate ratios, and rate differences for the selected strategies under each approach. FINDINGS In all cities, optimal combination strategies under the equity approach generated more QALYs than those with proportional services, ranging from a 3·1% increase (95% credible interval [CrI] 1·4-5·3) in New York to more than double (101·9% [75·4-134·6]) in Atlanta. Compared with proportional services, the equity approach delivered lower costs over 20 years in all cities except Los Angeles; cost reductions ranged from $22·9 million (95% CrI 5·3-55·7 million) in Seattle to $579·8 million (255·4-940·5 million) in Atlanta. The equity approach also reduced incidence disparities and health inequality measures in all cities except Los Angeles. INTERPRETATION Equity-focused HIV combination implementation strategies that reduce disparities for Black and Hispanic or Latinx individuals can significantly improve population health, reduce costs, and drive progress towards Ending the HIV Epidemic goals in the USA. FUNDING National Institute on Drug Abuse.
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Affiliation(s)
- Amanda My Linh Quan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Cassandra Mah
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Emanuel Krebs
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Xiao Zang
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Siyuan Chen
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Keri Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wendy Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Czarina Navos Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Julia C Dombrowski
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Eva Enns
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Leonard M Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Kelly A Gebo
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Matthew Golden
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Shruti H Mehta
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ankur Pandya
- T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | | | | | - Hansel Tookes
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
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Hood JE, Behrends CN, Irwin A, Schackman BR, Chan D, Hartfield K, Hess J, Banta-Green C, Whiteside L, Finegood B, Duchin J. The projected costs and benefits of a supervised injection facility in Seattle, WA, USA. Int J Drug Policy 2019; 67:9-18. [PMID: 30802842 DOI: 10.1016/j.drugpo.2018.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 12/06/2018] [Accepted: 12/30/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND As one strategy to improve the health and survival of people who inject drugs, the King County Heroin & Opioid Addiction Task Force recommended the establishment of supervised injection facilities (SIF) where people can inject drugs in a safe and hygienic environment with clinical supervision. Analyses for other sites have found them to be cost-effective, but it is not clear whether these findings are transferable to other settings. METHODS We utilized local estimates and other data sources deemed appropriate for our setting to implement a mathematical model that assesses the impact of a hypothetical SIF on overdose deaths, non-fatal overdose health service utilization, skin and soft tissue infections, bacterial infections, viral infections, and enrollment in medication assisted treatment (MAT). We estimated the costs and savings that would occur on an annual basis for a small-scale pilot site given current overdose rates, as well as three other scenarios of varying scale and underlying overdose rates. RESULTS Assuming current overdose rates, a hypothetical Seattle SIF in a pilot phase is projected to annually reverse 167 overdoses and prevent 6 overdose deaths, 45 hospitalizations, 90 emergency department visits, and 92 emergency medical service deployments. Additionally, the site would facilitate the enrollment of 41 SIF clients in medication assisted treatment programs. These health benefits correspond to a monetary value of $5,156,019. The annual estimated cost of running the SIF is $1,222,332. The corresponding cost-benefit ratio suggests that the pilot SIF would generate $4.22 for every dollar spent on SIF operational costs. The pilot SIF is projected to save the healthcare system $534,453. If Seattle experienced elevated overdose rates and Seattle SIF program were scaled up, the health benefits and financial value would be considerably greater. CONCLUSION This analysis suggests that a SIF program in Seattle would save lives and result in considerable health benefits and cost savings.
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Affiliation(s)
- J E Hood
- Public Health - Seattle & King County, 401 Fifth Avenue, Suite 1250, Seattle, WA, United States.
| | - C N Behrends
- Weill Cornell Medical College, 1300 York Ave. Box 65, New York, NY, 10065, United States
| | - A Irwin
- Law Enforcement Action Partnership, Silver Spring, MD, United States
| | - B R Schackman
- Weill Cornell Medical College, 1300 York Ave. Box 65, New York, NY, 10065, United States
| | - D Chan
- King County Department of Community and Health Services, 401 Fifth Avenue, Suite 500, Seattle, WA, United States; University of Washington, School of Public Health, 1959 NE Pacific St, Seattle, WA, 98195, United States
| | - K Hartfield
- Public Health - Seattle & King County, 401 Fifth Avenue, Suite 1250, Seattle, WA, United States
| | - J Hess
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, United States
| | - C Banta-Green
- University of Washington, School of Public Health, 1959 NE Pacific St, Seattle, WA, 98195, United States
| | - L Whiteside
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, United States
| | - B Finegood
- King County Department of Community and Health Services, 401 Fifth Avenue, Suite 500, Seattle, WA, United States
| | - J Duchin
- Public Health - Seattle & King County, 401 Fifth Avenue, Suite 1250, Seattle, WA, United States; University of Washington, School of Public Health, 1959 NE Pacific St, Seattle, WA, 98195, United States; University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, United States
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