Challenges in Motivating Treatment Enrollment in Community Syringe Exchange Participants

Participation in syringe exchange programs (SEPs) is associated with many individual and public health benefits, but may have little impact on reducing drug use without concurrent treatment engagement. The present study evaluated rates of drug use, other risk behaviors, and illegal activities in newly registered SEP participants (n = 240) enrolled versus not enrolled in substance abuse treatment over a 4-month observation window, and examined the effect of days in treatment on these outcomes. After controlling for baseline differences, SEP registrants enrolled in treatment (n = 113) reported less days of opioid and cocaine use, injection drug use, illegal activities, and incarceration than those not enrolled in treatment (n=127). For those enrolled in treatment, days of treatment was strongly correlated with each of these outcomes. These findings provide good evidence for a dose-response effect of treatment in syringe exchangers, and suggest that substance abuse treatment significantly expands the harm reduction benefits of SEP participation.Keywords syringe exchange; substance abuse treatment; injection drug use; HIV risk behaviors; harm reduction I.0 IntroductionCommunity syringe exchange programs (SEPs) are consistently associated with reduced rates of injection equipment sharing and reduced rates of HIV infection (e.g., Bluthenthal, Kral, Gee, Erringer, & Edlin, 2000;Des Jarlais et al., 1996;Des Jarlais, McKnight, Goldblatt, & Purchase, 2009;Gibson et al., 2002;Huo & Ouellet, 2007; see Wodak & Cooney, 2006 for a review). The fact that syringe exchange participation does not fully suppress the sharing of injection equipment is most likely related to the high rates of continuing drug injection in this subgroup of substance users (e.g., Des Jarlais, Braine, Yi, & Turner, 2007;Fisher, Fenaughty, Cagle, & Wells, 2003;Wood et al., 2002). Interventions that fully suppress drug injection would clearly enhance the harm reduction benefits of syringe exchanges. A recent study by Van Den Berg, Smit, Van Brussel, Coutinho, & Prins (2007) reached this conclusion in a study of 714 injection drug users in Amsterdam. Subjects in that study that concurrently participated in syringe exchange and substance Phone for First Author: Phone: (410) 550-0006, Fax: (410) 550-2957, mkidorf@jhmi.edu Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. While several studies have reported on promising strategies to bridge syringe exchange and substance abuse treatment participation (Kidorf et al., 2009;Kuo et al., 2003;Strathdee et al., 2006), little is known about the responsiveness of syringe...

Section: Reduction Of Drug Usesupporting

confidence: 78%

Section: Bridging Sep and Treatment Participationmentioning

confidence: 99%

Benefits of concurrent syringe exchange and substance abuse treatment participation

Kidorf¹,

King²,

Pierce³

et al. 2011

“…Those using illicit buprenorphine are a key group to target, because they often did not know where to go for BMT, but 83% reported they were very likely to initiate treatment, if BMT was offered onsite at harm reduction agencies. Previous data regarding referral to methadone maintenance treatment programs from harm reduction agencies suggest that initiation of treatment following referral may be as low as 5% (Kidorf et al, 2005). BMT may be prescribed in office-based settings, so directly initiating BMT onsite at harm reduction agencies may be a better option than referral to address the treatment gap.…”

Section: Discussionmentioning

confidence: 99%

Illicit buprenorphine use, interest in and access to buprenorphine treatment among syringe exchange participants

Fox

Chamberlain

Sohler

et al. 2015

Poor access to buprenorphine maintenance treatment (BMT) may contribute to illicit buprenorphine use. This study investigated illicit buprenorphine use and barriers to BMT among syringe exchange participants. Computer-based interviews conducted at a New York City harm reduction agency determined: prior buprenorphine use; barriers to BMT; and interest in BMT. Of 102 opioid users, 57 had used illicit buprenorphine and 32 had used prescribed buprenorphine. When illicit buprenorphine users were compared to non-users: barriers to BMT (“did not know where to get treatment”) were more common (64% vs. 36%, p < 0.01); mean levels of interest in BMT were greater (3.37 ± 1.29 vs. 2.80 ± 1.34, p = 0.03); and more participants reported themselves likely to initiate treatment (82% vs. 50%, p < 0.01). Illicit buprenorphine users were interested in BMT but did not know where to go for treatment. Addressing barriers to BMT could reduce illicit buprenorphine use.

“…Brief motivational interventions have been successfully deployed in clinical and community outreach (e.g., NSEP) settings to increase patients’ readiness for treatment (Booth, Kwiatkowski, Iguchi, Pinto, & John, 1998; Kidorf, et al, 2005; Strathdee, et al, 2006). Brief cognitive interventions, while originally tested on individuals with alcohol use disorders (Maisto, et al, 2001; Rollnick, Heather, Gold, & Hall, 1992; Wilk, Jensen, & Havighurst, 1997), have been efficacious in increasing treatment entry for cocaine, heroin and amphetamine users (Baker, Boggs, & Lewin, 2001; Bernstein, et al, 2005; Saunders, Wilkinson, & Phillips, 1995).…”

Section: Discussionmentioning

confidence: 99%

Treatment Readiness, Attitudes Toward, and Experiences with Methadone and Buprenorphine Maintenance Therapy Among People Who Inject Drugs in Malaysia

Vijay

Bazazi

Yee

et al. 2015

Background Little is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population. Methods In 2010, 460 people who inject drugs in Greater Kuala Lumpur, Malaysia were surveyed to evaluate attitudes toward and experience with OMT and treatment readiness. Attitudes towards OMT with both methadone and buprenorphine were assessed using an opinions scale. Multivariable linear regression was used to assess correlates of treatment readiness, measured with the 19-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Results All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Few had had previous experience with methadone (9.3%) or buprenorphine (12.6%) maintenance therapy, yet many had used methadone (55.2%) or buprenorphine (51.7%) outside of treatment settings. Fifteen percent had injected buprenorphine in the past month, and of the few that were currently receiving buprenorphine maintenance therapy, almost all were injecting it. The majority of subjects exhibited a moderate level of treatment readiness and a preference for methadone over buprenorphine. Those with low treatment readiness scores were more likely to have previous experience with compulsory drug detention centers (p<0.01), needle/syringe exchange programs (p<0.005), or be of Indian ethnicity (p<0.001). Past use of methadone (p<0.01), older age (p<0.001), stress symptom severity (p<0.001), and sharing of needles or syringes (p<0.05) were associated with higher treatment readiness scores. Conclusion There are suboptimal levels of OMT experience among people who inject drugs that may be improved by addressing factors that influence patient attitudes. Those individuals with moderate treatment readiness may be targeted by brief motivational and cognitive interventions in primary care, prisons or OMT clinics aimed at improving entry into and retention in treatment.