Drug treatment programs are uniquely situated to screen patients for antibodies for hepatitis C virus (HCV), an infectious disease that has reached epidemic proportions among drug users. This paper compares the accessibility and patients' use of opportunities for HCV antibody testing in a large sample of methadone and drug-free treatment programs (N=256) in the US, and reports programs' recent changes and future plans concerning it. Results indicate that almost all methadone and about two-thirds of drug-free programs in the sample provided HCV antibody screening to at least some patients in 2001. While about two-thirds of the methadone and close to one-third of the drug-free programs offered this service to all patients, these programs report that only about 3/5 of their patients actually provided specimens for testing for HCV antibodies. Some drug treatment programs were planning to increase the availability and accessibility of HCV antibody screening, but others were planning to cut back on these services, primarily due to limited resources. These results can inform policymakers who advocate for increased HCV antibody screening in drug treatment programs about the current level and future plans for implementing these services, illuminating where resources and motivational efforts need to be targeted.
"While substance dependence is a chronic relapsing disorder (NIDA, 2004), for inhalers, relapse prevention should be a prominent therapeutic goal for those considering leaving treatment prematurely, since they are at high risk of blood-borne viruses if their relapse leads to injecting. Clients should be vaccinated for hepatitis B and tested for hepatitis C antibodies, as these are critical components in the response to the HCV epidemic among drug users (Strauss et al., 2004). Those who are positive should be counseled to modify their behaviors to decrease alcohol consumption. "
[Show abstract][Hide abstract] ABSTRACT: AIMS: To undertake an exploratory study to examine the characteristics of patients in narcotic treatment programs who started their use of black tar heroin either as inhalers or as injectors and to compare them with those who started as inhalers but shifted to injecting. Other studies in this area have used subjects using other forms of heroin more amenable to inhaling. PARTICIPANTS, DESIGN, AND MEASUREMENT: A purposive sample of 199 patients in 6 methadone programs in Texas were interviewed in 2002-2003 using a structured instrument. FINDINGS: At admission to treatment, those who were heroin inhalers were more likely to be African American, to live with their families, to have income from wages, and to report fewer days of problems on most of the ASI measures. Those who shifted from inhaling to injecting were more likely to be Hispanic and to have had mental health problems that interfered with their lives and to have had less nurturing while growing up. Injectors were older at this treatment admission, had more treatment episodes and more times in jail, and were more likely to have hepatitis C, AIDS, or gonorrhea. There were high levels of physical and mental problems and histories of traumatization as children and adults for almost all the respondents. Males were as likely as females to have been sexually abused as children or as adults. CONCLUSIONS: The high rates of mental and physical problems among all the clients interviewed showed the need for comprehensive services to be delivered within the substance abuse treatment programs. Histories of trauma and sexual abuse should be addressed for both male and female clients.
Journal of Maintenance in the Addictions 03/2006; 3(1):61-82. DOI:10.1300/J126v03n01_06
[Show abstract][Hide abstract] ABSTRACT: Injection drug users (IDUs) have the highest rate of HCV infection. Although IDUs need support to access and use HCV services, they often lack this support. Many IDUs, however, have contact with a methadone maintenance treatment program (MMTP) where they can gain access to HCV services and obtain support in using them. Unfortunately, however, IDUs often underutilize the MMTP services that are available to them. Using qualitative data collected in 4 MMTPs, we identify some reasons for clients' lack of HCV service utilization and staff strategies that influence clients' perceptions of support in using these services.
Journal of Maintenance in the Addictions 04/2005; 3(1). DOI:10.1300/J126v03n01_04
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