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.
|Number of pages||8|
|Journal||Drug and Alcohol Dependence|
|State||Published - Jul 27 2006|
Bibliographical noteFunding Information:
The authors gratefully acknowledge support from the National Institute on Drug Abuse (grant number DA09225), Dr. David Vlahov, Dr. Peter Hartsock, staff of the Baltimore Needle Exchange Program and Baltimore Substance Abuse Systems, Inc. and associated drug treatment programs, and staff and participants of the Treatment Retention Intervention. This manuscript is dedicated to the memory of Dr. Harvey Siegal who was instrumental in the design of this evaluation.
- Case management
- Drug abuse treatment
- Injection drug use
- Methadone maintenance
- Needle exchange programs
ASJC Scopus subject areas
- Psychiatry and Mental health
- Pharmacology (medical)