Predictors of opiate agonist treatment retention among injection drug users referred from a needle exchange program

Jennifer R. Havens, Carl A. Latkin, Minya Pu, Llewellyn J. Cornelius, David Bishai, Steve Huettner, Charles Rapp, Erin P. Ricketts, Jacqueline J. Lloyd, Steffanie A. Strathdee

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Aims: The aim of this study was to examine the effect of a case management intervention on retention in opiate agonist therapy among injection drug users (IDUs) referred from a needle exchange program (NEP). Design, intervention, participants, and setting: A randomized trial of a strengths-based case management intervention versus passive referral (control) was conducted among NEP attendees requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Measurements: Multivariable Cox regression models were used to identify predictors of treatment retention using an ecological model approach, taking into account factors at the individual, social, and environmental level. Findings: Of 245 IDUs, 127 (51.8%) entered opiate agonist treatment, for whom median retention was 7.9 months. The intervention was not associated with longer retention (p = .91). Individual-level factors predictive of shorter retention included being employed and greater levels of psychiatric distress. Participants who had prior treatment experience and multiple treatment requests were retained significantly longer. Social factors adversely affecting treatment retention included unstable housing and buying drugs for others. Living further away from the treatment site was an environmental barrier that negatively affected treatment retention. Conclusions: Multilevel interventions that address individual, social, and environmental factors are necessary to improve substance abuse treatment retention and treatment outcomes among IDUs referred from NEP.

Original languageEnglish
Pages (from-to)306-312
Number of pages7
JournalJournal of Substance Abuse Treatment
Issue number3
StatePublished - Apr 2009

Bibliographical note

Funding Information:
This research was funded by the National Institute on Drug Abuse (Grant DA09225 to S.S.). In addition, the authors would like to thank the study participants and staff of the Baltimore Needle Exchange Project and Treatment Retention Intervention evaluation study along with Dr. Peter Hartsock.


  • Injection drug use
  • Needle exchange
  • Opioid agonist therapy
  • Strengths-based case management
  • Treatment retention

ASJC Scopus subject areas

  • Psychiatric Mental Health
  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health


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