title: A high proportion of users of low-threshold facilities with needle exchange programmes in Switzerland are currently on methadone treatment: implications for new approaches in harm reduction and care.
abstract: BACKGROUND
  Increasingly, patients receiving methadone treatment are found in low threshold facilities (LTF), which provide needle exchange programmes in Switzerland. This paper identifies the characteristics of LTF attendees receiving methadone treatment (MT) compared with other LTF attendees (non-MT).
  
  
  METHODS
  A national cross-sectional survey was conducted in 2006 over five consecutive days in all LTF (n=25). Attendees were given an anonymous questionnaire, collecting information on socio-demographic indicators, drug consumption, injection, methadone treatment, and self-reported HIV and HCV status. Univariate analysis and logistic regression were performed to compare MT to non-MT. The response rate was 66% (n=1128).
  
  
  RESULTS
  MT comprised 57.6% of the sample. In multivariate analysis, factors associated with being on MT were older age (OR: 1.38), being female (OR: 1.60), having one's own accommodation (OR: 1.56), receiving public assistance (OR: 2.29), lifetime injecting (OR: 2.26), HIV-positive status (OR: 2.00), and having consumed cocaine during the past month (OR: 1.37); MT were less likely to have consumed heroin in the past month (OR: 0.76, not significant) and visited LTF less often on a daily basis (OR: 0.59). The number of injections during the past week was not associated with MT.
  
  
  CONCLUSIONS
  More LTF attendees were in the MT group, bringing to light an underappreciated LTF clientele with specific needs. The MT group consumption profile may reflect therapeutic failure or deficits in treatment quality and it is necessary to acknowledge this and to strengthen the awareness of LTF personnel about potential needs of MT attendees to meet their therapeutic goals.
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), University Hospital Center and University of Lausanne, Bugnon 17, CH-1005 Lausanne, Switzerland. Jean-Pierre.Gervasoni@chuv.ch
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Gervasoni
authors.forename: Hugues
authors.initials: H
authors.lastname: Balthasar
authors.forename: Thérèse
authors.initials: T
authors.lastname: Huissoud
authors.forename: André
authors.initials: A
authors.lastname: Jeannin
authors.forename: Françoise
authors.initials: F
authors.lastname: Dubois-Arber
mesh_terms: D000328:Adult; D000367:Age Factors; D003042:Cocaine / Q000008:administration & dosage / Q000633:toxicity; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications; D040261:Harm Reduction; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008691:Methadone / Q000627:therapeutic use*; D018671:Needle-Exchange Programs; D058850:Opiate Substitution Treatment / Q000379:methods* / Q000523:psychology; D009293:Opioid-Related Disorders / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D011159:Population Surveillance; D012727:Sex Characteristics; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000523:psychology / Q000534:rehabilitation; D013557:Switzerland
chemical_list: D003042:Cocaine; D008691:Methadone