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Substance Abuse Treatment, Prevention, and Policy
Published in: Substance Abuse Treatment, Prevention, and Policy 1/2018

Open Access 01-12-2018 | Short report

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

Authors: Barbara Tempalski, Charles M. Cleland, Leslie D. Williams, Hannah L. F. Cooper, Samuel R. Friedman

Published in: Substance Abuse Treatment, Prevention, and Policy | Issue 1/2018

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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.
Footnotes
1
In TEDS, non-injectors are defined as clients who use illicit drugs via other routes of administration than injection, such as oral, inhalation, or smoked.
 
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Metadata
Title
Change and variability in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993–2007
Authors
Barbara Tempalski
Charles M. Cleland
Leslie D. Williams
Hannah L. F. Cooper
Samuel R. Friedman
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Substance Abuse Treatment, Prevention, and Policy / Issue 1/2018
Electronic ISSN: 1747-597X
DOI
https://doi.org/10.1186/s13011-018-0165-2

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