title: Persistence of low drug treatment coverage for injection drug users in large US metropolitan areas.
abstract: OBJECTIVE
  Injection drug users (IDUs) are at high risk for HIV, hepatitis, overdose and other harms. Greater drug treatment availability has been shown to reduce these harms among IDUs. Yet, little is known about changes in drug treatment availability for IDUs in the U.S. This paper investigates change in drug treatment coverage for IDUs in 90 metropolitan statistical areas (MSAs) during 1993-2002.
  
  
  METHODS
  We define treatment coverage as the percent of IDUs who are in treatment. The number of IDUs in drug treatment is calculated from treatment entry data and treatment census data acquired from the Substance Abuse and Mental Health Service Administration, divided by our estimated number of IDUs in each MSA.
  
  
  RESULTS
  Treatment coverage was low in 1993 (mean 6.7%; median 6.0%) and only increased to a mean of 8.3% and median of 8.0% coverage in 2002.
  
  
  CONCLUSIONS
  Although some MSAs experienced increases in treatment coverage over time, overall levels of coverage were low. The persistence of low drug treatment coverage for IDUs represents a failure by the U.S. health care system to prevent avoidable harms and unnecessary deaths in this population. Policy makers should expand drug treatment for IDUs to reduce blood-borne infections and community harms associated with untreated injection drug use.
authors.affiliation: National Development and Research Institutes, Inc, 71 West 23rd Street, 8th Fl, New York, NY 10010, USA. tempalski@ndri.org
authors.forename: Barbara
authors.initials: B
authors.lastname: Tempalski
authors.forename: Charles M
authors.initials: CM
authors.lastname: Cleland
authors.forename: Enrique R
authors.initials: ER
authors.lastname: Pouget
authors.forename: Sudip
authors.initials: S
authors.lastname: Chatterjee
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Friedman
mesh_terms: D016208:Databases, Factual; D006801:Humans; D040242:Risk Reduction Behavior; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000628:therapy*; D014481:United States; D014505:Urban Population