Top

Substance Abuse Treatment, Prevention, and Policy

Published in:

Open Access 01-12-2018 | Research

Use of withdrawal management services among people who use illicit drugs in Vancouver, Canada

Authors: Sharon Vipler, Kanna Hayashi, M.-J. Milloy, Evan Wood, Ekaterina Nosova, Thomas Kerr, Lianping Ti

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

Abstract

Background

For many individuals with substance use disorders, the entry point for addiction treatment can be through withdrawal management (e.g. detoxification) services. However, little is known about the factors that predict withdrawal management service use among people who use illicit drugs (PWUD). Using data derived from two prospective cohorts of PWUD, we conducted a longitudinal data analysis of factors associated with use of withdrawal management services.

Methods

Individuals participating in two cohorts of PWUD were prospectively followed between December 2005 and May 2016 in Vancouver, Canada. Bivariate and multivariate generalized estimating equations were used to examine factors associated with use of withdrawal management services.

Results

Out of a total of 2001 participants, 339 (16.9%) individuals reported having been to a withdrawal management centre in the previous 6 months at some point during the study period. In multivariate analyses, male sex (adjusted odds ratio [AOR]: 1.62, 95% Confidence Interval [CI]: 1.17–2.24), homelessness (AOR: 1.86, 95% CI: 1.45–2.38), binge use of any substance (AOR: 1.34, 95% CI: 1.08–1.67), having attended a supervised injection facility (AOR: 1.66, 95% CI: 1.3–2.11), and having accessed other addiction medicine treatment or supports (other than withdrawal management services or opioid agonist therapy; AOR: 3.34, 95% CI: 2.64–4.22) were positively associated with having accessed withdrawal management services, whereas older age (AOR: 0.81, 95% CI: 0.7–0.94) was negatively associated with the outcome.

Conclusions

This study identified specific factors associated with accessing withdrawal management services. Current evidence suggests a need to re-examine the provision of withdrawal management services. Consideration needs to be given to redesigning access to care and bridging to evidence-based addiction treatment, particularly for highly vulnerable subpopulations, identified in this study as females and older people.

Blanch B, Pearson SA, Haber PS. An overview of the patterns of prescription opioid use, costs and related harms in Australia. Br J Clin Pharmacol. 2014;78:1159–66.CrossRefPubMedPubMedCentral

Volkow N, Frieden T, Hyde P, Cha S. Medications assisted therapies -- tackling the opioid-overdose epidemic. N Engl J Med. 2014;370:2063–5. https://doi.org/10.1056/NEJMp1404181.CrossRefPubMed

Kerensky T, Walley AY. Opioid overdose prevention and naloxone rescue kits: what we know and what we don’t know. Addict Sci Clin Pract. 2017;12:4. https://doi.org/10.1186/s13722-016-0068-3.CrossRefPubMedPubMedCentral

Lange R, Hillis D. Cardiovascular complications of cocaine use. N Engl J Med. 2001;345:351–8.CrossRefPubMed

Glauser J, Queen JR. An overview of non-cardiac cocaine toxicity. J Emerg Med. 2007;32:181–6.CrossRefPubMed

Falk D, Yi HY, Hiller-Sturmhöfel S. An epidemiologic analysis of co-occurring alcohol and drug use and disorders. Alcohol Res Heal. 2008;31:100–10. http://www.scopus.com/inward/record.url?eid=2-s2.0-51349087250&partnerID=tZOtx3y1.

Staines GL, Magura S, Foote J, Deluca A, Kosanke N. Polysubstance use among alcoholics. J Addict Dis. 2001;20:57–73. https://doi.org/10.1300/J069v20n04_06.CrossRef

Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet. 2009;373:2223–33.CrossRefPubMed

Schuckit MA. Alcohol-use disorders. Lancet. 2009;373:492–501. https://doi.org/10.1016/S0140-6736(09)60009-X.CrossRefPubMed

10.

World Health Organization, and World Health Organization. Management of Substance Abuse Unit. Global status report on alcohol and health (2014). World Health Organization; 2014.

11.

SAMHSA. Center for Subst Abus Treatment. Detoxification and Subst Abus Treatment. Rockville (MD): Subst Abus and Mental Health Services Administration (US); 2015. (Treatment Improvement Protocol (TIP) Series, No. 45.); 2015. Available from: https://store.samhsa.gov/shin/content/SMA13-4131/SMA13-4131.pdf.

12.

Amato L, Davoli M, Minozzi S, Ferroni E, Ali R, Ferri M. Methadone at tapered doses for the management of opioid withdrawal.In L. Amato (Ed.), Cochrane Database of Systematic Reviews. Chichester: Wiley; 2013. https://doi.org/10.1002/14651858.CD003409.pub4.

13.

Minozzi S, Amato L, Davoli M. Detoxification treatments for opiate dependent adolescents. The Cochrane database of systematic reviews. 2009(2):CD006749–CD006749.

14.

Kleber HD. Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues Clin Neurosci. 2007;9:455–70.PubMedPubMedCentral

15.

British Columbia Centre on Substance Use. A Guideline for the Clinical Management of Opoid Use Disorder. 2017.

16.

Fraser Health Authority Withdrawal Management. 2018. https://www.fraserhealth.ca/health-info/mental-health-substance-use/substance-use/adult-substance-use-services/withdrawal-management-detox-daytox/. Accessed 3 May 2018.

17.

Northern Health Authority Adult Withdrawal Management Unit. 2018. https://www.northernhealth.ca/YourHealth/MentalHealthAddictions/ProgramDescriptions/AdultWithdrawalManagementUnit.aspx. Accessed 3 May 2018.

18.

Vancouver Coastal Health Authority Substance Use Services. 2018. http://www.vch.ca/your-care/mental-health-substance-use/substance-use-services. Accessed 3 May 2018.

19.

Fisher DG, Ph D, Reynolds GL, A DP, Anna LHD, Hosmer DW, et al. Journal of substance abuse treatment failure to get into substance abuse treatment. J Subst Abus Treat. 2017;73:55–62. https://doi.org/10.1016/j.jsat.2016.11.004.CrossRef

20.

DeBeck K, Kerr T, Nolan S, Dong H, Montaner J, Wood E, et al. Inability to access addiction treatment predicts injection initiation among street-involved youth in a Canadian setting. Subst Abuse Treat Prev Policy. 2016;11(1) https://doi.org/10.1186/s13011-015-0046-x.

21.

Prangnell A, Daly-Grafstein B, Dong H, Nolan S, Milloy M-J, Wood E, et al. Factors associated with inability to access addiction treatment among people who inject drugs in Vancouver, Canada. Subst Abuse Treat Prev Policy. 2016;11 https://doi.org/10.1186/s13011-016-0053-6.

22.

Appel PW, Ellison AA, Jansky HK, Oldak R. Barriers to enrollment in drug abuse treatment and suggestions for reducing them: opinions of drug injecting street outreach clients and other system stakeholders. Am J Drug Alcohol Abuse. 2004;30:129–53. https://doi.org/10.1081/ADA-120029870.CrossRefPubMed

23.

Tyndall MW, Currie S, Spittal P, Li K, Wood E, O’Shaughnessy MV, et al. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003;17:887–93. https://doi.org/10.1097/01.aids.0000050859.71999.ae.CrossRefPubMed

24.

Strathdee SA, Patrick DM, Currie SL, Cornelisse PGA, Rekart ML, Montaner JSG, et al. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997;11:F59–65.CrossRefPubMed

25.

For APG. A pocket guide for alcohol screening and brief intervention. A Pocket Guid Alcohol Screen Br Interv. 2005;:2. doi:https://doi.org/10.1016/j.nurpra.2005.12.020.

26.

Batts K, Pemberton M, Bose J, Weimer B, Henderson L, Penne M, et al. Comparing and Evaluating Substance Use Treatment Utilization Estimates from National Survey on Drug Use and Health and Other Data Sources. CBHSQ Data Rev. 2014; April:120. http://www.samhsa.gov/data/sites/default/files/NSDUH-DR-Task2SubUseTx-2014/NSDUH-DR-Task2SubUseTx-2014.pdf.

27.

Arfken CL, Klein C, di Menza S, Schuster CR. Gender differences in problem severity at assessment and treatment retention. J Subst Abus Treat. 2001;20:53–7. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med4&NEWS=N&AN=11239728.CrossRef

28.

Westermeyer J, Boedicker a E. Course, severity, and treatment of substance abuse among women versus men. Am J Drug Alcohol Abuse. 2000;26:523–35. https://doi.org/10.1081/ADA-100101893.CrossRefPubMed

29.

Greenfield S, Brooks A, Gordon S, Green C, Kropp F, Mchugh RK, et al. Substance abuse treatment entry, retention and outcome in women: a review of the literature. Drug Alcohol Depend. 2012;86:1–21.CrossRef

30.

Amaro H, Hardy-Fanta C. Gender relations in addiction and recovery. J Psychoactive Drugs. 1995;27:325–37. http://www.ncbi.nlm.nih.gov/pubmed/8788689.CrossRefPubMed

31.

Hernandez-Avila CA, Rounsaville BJ, Kranzler HR. Opioid-, cannabis- and alcohol-dependent women show more rapid progression to substance abuse treatment. Drug Alcohol Depend. 2004;74:265–72.CrossRefPubMed

32.

Zlotnick C, Tam T, Robertson MJ. Disaffiliation, substance use, and exiting homelessness. Subst Use Misuse. 2003;38:577–99.CrossRefPubMed

33.

Ibabe I, Stein JA, Nyamathi A, Bentler PM. Predictors of substance abuse treatment participation among homeless adults. J Subst Abus Treat. 2014;46:374–81. https://doi.org/10.1016/j.jsat.2013.10.008.CrossRef

34.

Schultz NR, Martinez R, Cucciare MA, Timko C. Patient, program, and system barriers and facilitators to detoxification services in the U.S. veterans health administration: a qualitative study of provider perspectives. Subst Use Misuse. 2016;51:1330–41. https://doi.org/10.3109/10826084.2016.1168446.CrossRefPubMed

35.

Wood E, Tyndall MW, Zhan R, Stoltz J-A, Lai C, Montaner JSG, et al. Attendance at supervised injecting facilities. N Engl J Med. 2006;354:2512–4.CrossRefPubMed

36.

Wood E, Tyndall MW, Zhang R, Montaner JSG, Kerr T. Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction. 2007;102:916–9.CrossRefPubMed

37.

Riley ED, Wu AW, Junge B, Marx M, Strathdee SA, Vlahov D. Health services utilization by injection drug users participating in a needle exchange program. Am J Drug Alcohol Abuse. 2002;28:497–511. https://doi.org/10.1081/ADA-120006738.CrossRefPubMed

38.

Strathdee SA, Celentano DD, Shah N, Lyles C, Stambolis VA, Macalino G, et al. Needle-exchange attendance and health care utilization promote entry into detoxification. J Urban Health. 1999;76:448–60. https://doi.org/10.1007/BF02351502.CrossRefPubMedPubMedCentral

39.

Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend. 2014;145:48–68.CrossRefPubMed

40.

Rosen D, Hunsaker A, Albert SM, Cornelius JR, Reynolds CF. Characteristics and consequences of heroin use among older adults in the United States: a review of the literature, treatment implications, and recommendations for further research. Addict Behav. 2011;36:279–85. https://doi.org/10.1016/j.addbeh.2010.12.012.CrossRefPubMed

41.

Gelberg L, Gallagher TC, Andersen RM, Koegel P. Competing priorities as a barrier to medical care among homeless adults in Los Angeles. Am J Public Health. 1997;87:217–20.CrossRefPubMedPubMedCentral

42.

Smyth B., Barry J, Keenan E, Ducray K. Lapse and relapse following inpatient treatment of opiate dependence. Ir Med J 2010;103. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L359141772%5Cnhttp://www.imj.ie//IMJPage_0_1.aspx?issueid=418.

43.

Day E, Strang J. Outpatient versus inpatient opioid detoxification: a randomized controlled trial. J Subst Abus Treat. 2011;40:56–66.CrossRef

44.

Moos RH, Moos BS. Long-term influence of duration and intensity of treatment on previously untreated individuals with alcohol use disorders. Addiction. 2003;98:325–37.CrossRefPubMed

45.

Moyer A, Finney JW. Outcomes for untreated individuals involved in randomized trials of alcohol treatment. J Subst Abus Treat. 2002;23:247–52.CrossRef

46.

BC Centre on SubStance A Guideline for the Clinical Management of. 2017. http://www.bccsu.ca/wp-content/uploads/2017/06/BC-OUD-Guidelines_June2017.pdf.

Title: Use of withdrawal management services among people who use illicit drugs in Vancouver, Canada
Authors: Sharon Vipler
Kanna Hayashi
M.-J. Milloy
Evan Wood
Ekaterina Nosova
Thomas Kerr
Lianping Ti
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/s13011-018-0164-3

At a glance: The STEP trials

Springer Medicine

Use of withdrawal management services among people who use illicit drugs in Vancouver, Canada

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Smoking, alcohol consumption, and illicit substances use among adolescents in Poland

Weaved into the cultural fabric: a qualitative exploration of alcohol consumption during pregnancy among tribal women in Odisha, India

Evaluation of the psychometric properties of self-reported measures of alcohol consumption: a COSMIN systematic review

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

Assessing the validity and reliability of the Turkish versions of craving beliefs and beliefs about substance use questionnaire in patients with heroin use disorder: demonstrating valid tools to assess cognition-emotion interplay

Development and psychometric properties of the methamphetamine decisional balance scale (METH-DBS) for young adults