DRUG USER TREATMENT REFERRALS AND ENTRY AMONG PARTICIPANTS OF A NEEDLE EXCHANGE PROGRAM

Abstract

Objective. To compare characteristics of needle exchange program (NEP) participants who requested methadone treatment to those who did not, compare participants who subsequently enrolled into treatment to those who did not enroll, and suggest possible barriers to treatment among NEP participants. Methods and Materials. Between 8/94 and 2/97, data pertaining to demographics and drug use were collected from Baltimore NEP participants upon registration. Participants were made aware that referrals to off-site methadone maintenance were available upon request. Odds ratios and multiple logistic regression models were used to compare those who requested treatment to those who did not and those who entered treatment to those who did not enter. Results. Among 2659 NEP participants, 86% were African-American, 28% were female, 9% were employed, and the median age was 38 years. Requesting a drug user treatment referral was associated with female gender [Adjusted Odds Ratio (AOR) = 2.02], age >38 years (AOR = 1.96), use of speedballs during the past 6 months (AOR = 3.38), and age >20 years at time of first injection (AOR = 1.59). Among 139 individuals who requested treatment, males were twice as likely as females to enter treatment (OR = 2.45). In an open-ended survey, health insurance (p =. 02) and not living with children (p =. 01) were associated with drug user treatment entry. Conclusions. Even though female NEP participants were more likely to request methadone treatment, they were less likely than males to enter treatment. Although NEPs can be a bridge to drug user treatment, these data suggest that barriers to utilizing treatment referrals are important issues to resolve, especially for women who use community needle exchange programs.

• “Substance abuse”
• Injection
• Methadone maintenance
• Needle exchange
• Treatment barriers

RÉSUMÉ

Objectif. comparer chez les participants d’un programme d’échange d’aiguille (PEA), les caractéristiques des individus demandant un traitement au methadone à ceux qui ne l’ontpas demandé, comparer les participants qui ont plus tard accepté le traitement à ceux qui ne l’ont pas fait, et suggérer les obstacles au traitement chez les participants d’un PEA. Matériels et Méthodes. Entre Août 1994 et Fevrier 1997, des données concernant la démographie et l’utilisation de drogue a été collecté pour des participants inscrits à un PEA à Baltimore. Les participants ont été avertis de la possibilité d’un traitement au methadone disponible sur une base volontaire. Des modéles taux de chance et de regression logistique multiples ont été utilisés pour comparer les participants qui ont demandé le traitement à ceux qui ne l’ontpas demandé, ainsi que ceux qui ont accepté le traitement à ceux qui ne l’ont pas accepté. Résultats. Parmi les 2659 participant au PEA, 86% étaient noirs-américains, 28% étaient des femmes, 9% avaient un emploi, et l’âge median étaient de 38 ans. La demande d’un traitement anti-drogue était associé avec le sexe féminin (rapport de chance ajusté [RCA] = 2.02), un age supérieur à 38 ans (RCA = 1.96), l’usage de “speedballs” (cocaïne et héroïne) dans les 6 derniers mois (RCA = 3.38), et un âge de plus de 20 ans lors de la premiére injection (RCA = 1.59). Parmi 139 indivdus qui ont demandé le traitement, les hommes étaient deux fois plus penchés à subir le traitement (RC = 2.45). L’assurance-maladie (p =. 02) et l’absence d’enfants (p =. 01) étaient associés à l’entrée en traitement. Conclusions. Bien qu’elles étaient plus nombreuses à demander le traitement au methadone, les femmes participant au PEA étaient moins pencheés que les hommes à suivre le traitement. Meme si les PEA peuvent être un tramplin. Pour le traitement anti-drogue, ces données suggére que les barriéres contre l’utilisation du traitement sont d’importants problémes a régler, spécialement pour les femmes qui utilisent les programmes communautaire d’echange de aiguilles.

Additional information

Notes on contributors

Elise D. Riley

Elise D. Riley, Ph.D., is a postdoctoral research fellow with the Center for AIDS Prevention Studies at the University of California, San Francisco. For the past six years, her work has focused on issues surrounding the epidemiology of drug use including risky behavior change, syringe disposal, gender issues in access to treatment, mode of health service delivery, and data reliability. She is currently focusing on health and health care utilization among homeless and drug using individuals.

Mahboobeh Safaeian

Mahboobeh Safaeian, M.P.H., is pursuing a Ph.D. in epidemiology at the Johns Hopkins Bloomberg School of Public Health. She is interested in infectious diseases, specifically HIV, and in applying epidemiologic methods to HIV/AIDS research.

Steffanie A. Strathdee

Steffanie A. Strathdee, Ph.D., is an Associate Professor of Epidemiology at the Johns Hopkins University Bloomberg School of Public Health. Dr. Strathdee has published over 80 papers in peer reviewed journals relating to her research interests in HIV/AIDS prevention and natural history, and evaluation of needle exchange programs.

Robert K. Brooner

R. K. Brooner, Ph.D., is a Professor of Psychiatry at the Johns Hopkins University School of Medicine, and Director of Addiction Treatment Services at Johns Hopkins Bayview Medical Center. Dr. Brooner has 15 years of experience in the treatment of substance use disorder. He is also a Principal Investigator on several NIH/NIDA drug abuse treatment research projects, and has published extensively on both routine and novel treatment interventions, psychiatric comorbidity, and the role of community needle exchanges as conduits to drug abuse treatment programs.

Peter Beilenson

Peter Beilenson, M.D., M.P.H., has been the Commissioner of Health for the City of Baltimore since 1999. He is involved with drug treatment expansion for Baltimore, implementing a large-scale needle exchange program, contraceptive availability in schools for sexually active teenagers, immunization adherence, a lead poisoning prevention initiative, ensuring health care availability in every public school, and leading a state-wide initiative for universal health coverage in Maryland. Dr. Beilenson has published numerous articles in medical journals and was the first recipient of the Milton and Ruth Roemer Award for creativity by a local health official.

David Vlahov

David Vlahov, Ph.D., is Director for the Center for Urban Epidemiologic Studies at the New York Academy of Medicine and an Adjunct Professor of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, as well as Columbia University's Mailman School of Public Health.