Effect of a Case Management Intervention as Part of a Needle Exchange Program on Opioid Agonist Treatment Retention

Opioid agonist treatment retention is an important predictor of abstinence, reduction in risky behavior, and overall functioning among injection drug users (IDUs). However, many studies have focused on treatment entry rather than treatment retention. In this clinical trial, investigators sought to determine the impact of a case management intervention on treatment retention among 127 needle exchange program participants referred for opioid agonist treatment. Participants were assigned to receive either a strengths-based case management (SBCM) intervention with linkage to a drug treatment program or passive referral to a drug treatment program. As part of the SBCM model, participants in the intervention group were central in formulating their own treatment goals and received assistance in achieving those goals (e.g., transportation, child care, social services). The primary outcome was retention in drug treatment.

• Median treatment duration was 7.9 months. No difference in treatment retention was observed between the intervention and control groups.

• After adjusting for intervention status and randomization,

• factors predictive of shorter treatment duration included unstable housing (hazard ratio [HR], 1.79), buying drugs for others (HR, 1.84), living further from treatment site (HR, 2.15), and higher levels of psychiatric distress (HR, 2.22).
• factors predictive of longer treatment retention included prior treatment history (HR, 0.3), multiple treatment requests (HR, 0.6), and being unemployed (0.37).

Comments:

This study suggests that, although needle exchange programs are an important referral source for linking IDUs to substance abuse treatment, retention in treatment is not affected by case management provided through such programs. However, individual, social, and environmental factors did have an impact on whether patients remained in treatment, and focusing case management efforts in these areas may impact retention.

Jeanette M. Tetrault, MD

Reference:

Havens JR, Latkin CA, Pu M, et al. Predictors of opiate agonist treatment retention among injection drug users referred from a needle exchange program. J Subst Abuse Treat. 2009:36(3):306–312.