Acceptability and availability of harm-reduction interventions for drug abuse in American substance abuse treatment agencies.

Abstract

This study assessed acceptability, availability, and reasons for nonavailability of interventions designed to prevent drug use related harm by substituting pharmaceuticals for illicit drugs; facilitating detoxification; and reducing the occurrence of HIV transmission, relapse, and opiate overdose. A survey was mailed to a sample of 500 randomly selected American substance abuse treatment agencies. Of 435 potentially eligible respondents, 222 (51%) returned usable data. A subset of interventions--including harm reduction education, cue exposure therapy, needle exchange, substitute opiate prescribing, various detoxification regimes, and complementary therapies--were rated as somewhat or completely acceptable by 50% or more of the respondents. Regardless of their acceptability, listed interventions were generally not available from responding agencies; respondents typically attributed unavailability to lack of resources and inconsistency of an intervention with agency philosophy.

Deficit models and divergent philosophies: Service providers’ perspectives on barriers and incentives to drug treatment

“…However, there has been resistance to the adoption of harm reduction approaches, particularly in contexts where 12-step-style abstinence-based programs have been the dominant mode of drug treatment (Caplehorn et al, 1998;Goddard, 2003;Rosenberg & Phillips, 2003). Our findings suggest that harm reduction services may be better placed to offer flexible and individually tailored treatment to clients, given that they can accept that many clients aim for abstinence as the goal of drug treatment (McKeganey et al, 2004) while also acknowledging that abstinence can be difficult to achieve and that other outcomes may be more practical or acceptable (such as reduced levels of harmful or risky practice).…”

Addiction treatment services and co-occurring disorders: Prevalence estimates, treatment practices, and barriers

“…There have been numerous surveys of addiction treatment clinicians in which perceptions and practices with cooccurring disorders were not assessed (Ball et al, 2002;Foreman et al, 2002;Forman, Bovasso, & Woody, 2001;Gallon, Gabriel, & Knudsen, 2003;Lehman, Greener, & Simpson, 2002;Mulvey, Hubbard, & Hayashi, 2003;Rosenberg & Phillips, 2003). Several recent surveys have targeted co-occurring disorders among addiction treatment professionals.…”

Opioid Dose- and Route-Dependent Efficacy of Oxycodone and Heroin Vaccines in Rats

“…Medications to treat opioid abuse are available and effective, but less than 30% of individuals with opioid use disorder are receiving them (National Survey on Drug Use and Health, 2014). Treatment with the opioid receptor agonists methadone and buprenorphine is complicated due to their abuse liability, potential diversion, and strict administrative regulations (Rosenberg and Phillips, 2003;Appel et al, 2004). Treatment with the opioid antagonist naltrexone can complicate pain management and requires detoxification prior to initiation of treatment.…”