Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial

• Published in: Drug and alcohol dependence Vol. 83; no. 3; pp. 225 - 232
• Main Authors: Strathdee, Steffanie A., Ricketts, Erin P., Huettner, Steven, Cornelius, Lee, Bishai, David, Havens, Jennifer R., Beilenson, Peter, Rapp, Charles, Lloyd, Jacqueline J., Latkin, Carl A.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 27.07.2006; Elsevier Science
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Baltimore; Behavior Therapy; Biological and medical sciences; Case Management; Community based programmes; Community Mental Health Services; Drug abuse treatment; Drug addiction; Drug replacement therapy; Female; Health Services Accessibility; HIV Seroprevalence; HIV/AIDS; Human viral diseases; Humans; Infectious diseases; Injection drug use; Intravenous drug addicts; Male; Medical sciences; Methadone - therapeutic use; Methadone maintenance; Methadyl Acetate - therapeutic use; Middle Aged; Motivation; Narcotics - therapeutic use; Needle exchange programs; Needle exchange schemes; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - rehabilitation; Patient Acceptance of Health Care; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Referral and Consultation; Referrals; Substance Abuse, Intravenous - epidemiology; Substance Abuse, Intravenous - rehabilitation; Toxicology; Transportation; Urban Population; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Baltimore; HIV/AIDS; Injection drug use; Case management; Drug abuse treatment; Transportation; Needle exchange programs; Methadone maintenance; Replacement therapy; Intravenous administration; Managed care; Opiates; Methadone; Narcotic analgesic; Result; Maintenance treatment; Clinical trial; Community health; Behavior; Community action for health; Human; Immunopathology; Drug addiction; Program; Poison withdrawal; AIDS; Substance abuse; Immune deficiency; Infection; Exchange; Addiction; Viral disease; Needle; Syringe; Psychiatry
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2005.11.015

We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%, p = 0.03). In a multivariate “intention to treat’ model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional ‘as treated’ analyses revealed that participants who received 30 min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment.