title: Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial.
abstract: 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.
authors.affiliation: Division of International Health and Cross-Cultural Medicine, Department of Family and Preventive Medicine, University of California-San Diego, 9500 Gilman Drive, Ash Building, Room 118, Mailstop 0622, San Diego, CA 92093, USA. sstrathdee@ucsd.edu
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.forename: Erin P
authors.initials: EP
authors.lastname: Ricketts
authors.forename: Steven
authors.initials: S
authors.lastname: Huettner
authors.forename: Lee
authors.initials: L
authors.lastname: Cornelius
authors.forename: David
authors.initials: D
authors.lastname: Bishai
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Havens
authors.forename: Peter
authors.initials: P
authors.lastname: Beilenson
authors.forename: Charles
authors.initials: C
authors.lastname: Rapp
authors.forename: Jacqueline J
authors.initials: JJ
authors.lastname: Lloyd
authors.forename: Carl A
authors.initials: CA
authors.lastname: Latkin
mesh_terms: D000328:Adult; D015142:Baltimore; D001521:Behavior Therapy; D019090:Case Management; D003156:Community Mental Health Services; D005260:Female; D015528:HIV Seroprevalence; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008692:Methadyl Acetate / Q000627:therapeutic use; D008875:Middle Aged; D009042:Motivation; D009294:Narcotics / Q000627:therapeutic use; D018671:Needle-Exchange Programs; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000534:rehabilitation*; D014186:Transportation; D014505:Urban Population
chemical_list: D009294:Narcotics; D008692:Methadyl Acetate; D008691:Methadone