Change and variability in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993-2007

• Type of Material: Article
• Authors: Barbara Tempalski, NDRI, Inc.; Charles M. Cleland, New York University; Leslie D. Williams, NDRI, Inc.; Hannah Cooper, Emory University; Samuel R. Friedman, NDRI, Inc.
• Language: English
• Date: 2018-08-09
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s). 2018
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13011-018-0165-2
• Title of Journal or Parent Work: Substance Abuse Treatment, Prevention, and Policy
• ISSN: 1747-597X
• Volume: 13
• Issue: 1
• Start Page: 28
• End Page: 28
• Grant/Funding Information: This project was supported by the National Institute of Drug Abuse (R01 DA037568; Metropolitan Trajectories of HIV Epidemics and Responses in US Key Populations and, P30DA011041; Center for Drug Use & HIV Research).
• Keywords: Substance Abuse; BUPRENORPHINE; USERS; RISK; Metropolitan statistical areas; Drug treatment coverage; OVERDOSE DEATHS; PREVENTION; Opioids; HEROIN USE; Science & Technology; UNITED-STATES; Change over time; SURVEILLANCE SYSTEM; HIV-INFECTION; Life Sciences & Biomedicine; People who inject drugs; ANTIRETROVIRAL THERAPY
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

BACKGROUND: Our previous research has found low and stable mean drug treatment coverage among people who inject drugs (PWID) across 90 large US metropolitan statistical areas (MSAs) during 1993-2002. This manuscript updates previous estimates of change in drug treatment coverage for PWID in 90 MSAs during 1993-2007. METHODS: Our drug treatment sample for calculating treatment coverage includes clients enrolled in residential or ambulatory inpatient/outpatient care, detoxification services, and methadone maintenance therapy at publicly- and privately-funded substance abuse agencies receiving public funds. Coverage was measured as the number of PWID in drug treatment, calculated by using data from the Substance Abuse and Mental Health Service Administration, divided by numbers of PWID in each MSA. We modeled change in drug treatment coverage rates using a negative binomial mixed-effects model. Fixed-effects included an intercept and a main effect for time. Incidence rate ratios (IRR) were calculated for both average change from 1993 to 2007 and MSA-specific estimates of change in coverage rates. RESULTS: On average over all MSAs, coverage was low in 1993 (6.1%) and showed no improvement from 1993 to 2007 (IRR = 0.99; 95% CI, 0.86, 1.2). There was modest variability across MSAs in coverage in 1993 (log incidence rate SD = 0.36) as well as in coverage change from 1993 to 2007 (log IRR SD = 0.32). In addition, results indicate significant variability among MSAs in coverage. CONCLUSIONS: Inadequate treatment coverage for PWID may produce a high cost to society in terms of the spread of overdose mortality and injection-related infectious diseases. A greater investment in treatment will likely be needed to have a substantial and more consistent impact on injection drug use-related harms. Future research should examine MSA-level predictors associated with variability in drug treatment coverage.