Defining a service for people who use drugs as ‘low-threshold’: What should be the criteria?

Islam, M. Mofizul; Topp, Libby; Conigrave, Katherine M.; Day, Carolyn

doi:10.1016/j.drugpo.2013.03.005

Cited by 39 publications

(17 citation statements)

References 18 publications

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“…When it comes to treatment and service needs, low-threshold and/or harm reduction-based services were the most commonly reported need. Low-threshold programs have been defined differently [66], but essentially include ‘inviting’ atmospheres, effective client engagement, confidential service delivery, tailored services, and peer support to reduce stated barriers to service access. As a primary example, many youth participants suggested drop-in centers with on-the-spot help available 24 hours a day, run by peer counsellors as a service they would use and benefit from.…”

Section: Discussionmentioning

confidence: 99%

Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in Northern Ontario, Canada

et al. 2019

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BackgroundIllicit drug use rates are high among Canadian youth, and are particularly pronounced in Northern Ontario. The availability and accessibility of effective substance use-related treatments and services are required to address this problem, especially among rural and remote Northern communities. In order to assess specific service and treatment needs, as well as barriers and deterrents to accessing and utilizing services and treatments for youth who use illicit drugs in Northern Ontario, we conducted the present study.MethodsThis study utilized a mixed-methods design and incorporated a community-based participatory research approach. Questionnaires were administered in conjunction with audio-recorded semi-structured interviews and/or focus groups with youth (aged 14–25) who live in Northern Ontario and use illicit drugs. Interviews with ‘key informants’ who work with the youth in each community were also conducted. Between August and December 2017, the research team traveled to Northern Ontario communities and carried out data collection procedures.ResultsA total of 102 youth and 35 key informants from eleven different Northern Ontario communities were interviewed. The most commonly used drugs were prescription opioids, cocaine and crack-cocaine. Most participants experienced problems related to their drug use, and reported ‘fair’ mental and physical health status. Qualitative analyses highlighted an overall lack of services; barriers to accessing treatment and services included lack of motivation, stigmatization, long wait-lists and transportation/mobility issues. Articulated needs revolved around the necessity of harm reduction-based services, low-threshold programs, specialized programming, and peer-based counselling.ConclusionsAlthough each community varied in terms of drug use behaviors and available services, an overall need for youth-specific, low-threshold services was identified. Information gathered from this study can be used to help inform rural and remote communities towards improving treatment and service system performance and provision.

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Section: Discussionmentioning

confidence: 99%

Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in Northern Ontario, Canada

et al. 2019

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“…The rate of MMT discontinuation in our study (22%) was lower than has been observed other settings, where six-month retention rates typically range from 46 to 65% (Farré, Mas, Torrens, Moreno, & Camí, 2002 ; Magura et al, 1998; Nosyk et al, 2010 ; Reisinger et al, 2009). MMT provision in the province of British Columbia, Canada, is provided in the setting of ‘low threshold’ programs, where efforts are made to minimize barriers to service access, including through use of pharmacy-delegated methadone delivery services and outreach models of care, and by not requiring abstinence from drug use as a condition of MMT access (Mofizul Islam, Topp, Conigrave, & Day, 2013). We hypothesize that the ‘low threshold’ service provision model for MMT in our setting may contribute to the lower MMT discontinuation rates observed in our study.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with methadone maintenance therapy discontinuation among people who inject drugs

Kerr

Hayashi

et al. 2018

Journal of Substance Abuse Treatment

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Discontinuation of MMT in this urban setting was associated with recent homelessness and incarceration, not accessing social income assistance, as well as daily prescription opioid use and daily heroin injection drug use. These findings underscore a need to reduce potential barriers to MMT retention by providing access to stable housing and preventing treatment interruptions during transitions between community and custodial settings.

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“…Many social opportunities for drug users in treatment are in judgmental and high-threshold settings, in which problem drug use is seen as a choice, and drug users are required to adhere to many strict rules involving complete abstinence and other freedom deprivation aspects [37]. Although we can consider this service as low-threshold [25], stigma, marginalization, and oppression were still present and connected with difficulties in building trust between HCP and drug users in a harm reduction framework [4]. In this regard, through an understanding of therapeutic success as nuanced, low-threshold environments and non-judgmental interactions may allow trust and dialogue to develop among providers and users.…”

Section: Discussionmentioning

confidence: 99%

“…The service represents a novel landmark intervention in mental health care, providing a low-threshold environment in which the interactions between providers and users are ideally non-judgmental and the care is more accessible. The service aims to minimize harms related to problematic substance use, reducing admissions to psychiatric institutions, and promoting reintegration of these individuals into society by articulation with community service networks [25–28]. …”

Section: Methodsmentioning

confidence: 99%

Harm Reduction and Tensions in Trust and Distrust in a Mental Health Service: A Qualitative Approach

Lago

Peter

Bógus

2017

Subst Abuse Treat Prev Policy

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BackgroundPeople seeking care for substance use (PSCSU) experience deep social and health inequities. Harm reduction can be a moral imperative to approach these persons. The purpose of this study was to explore relationships among users, health care providers, relatives, and society regarding harm reduction in mental health care, using a trust approach rooted in feminist ethics.MethodsA qualitative study was conducted in a mental health service for PSCSU, and included fifteen participants who were health care providers, users, and their relatives. Individual in-depth and group interviews, participant observation, and a review of patients’ records and service reports were conducted.ResultsThree nested levels of (dis)trust were identified: (dis)trust in the treatment, (dis)trust in the user, and self-(dis)trust of the user, revealing the interconnections among different layers of trust. (Dis)trust at each level can amplify or decrease the potential for a positive therapeutic response in users, their relatives’ support, and how professionals act and build innovations in care. Distrust was more abundant than trust in participants’ reports, revealing the fragility of trust and the focus on abstinence within this setting.ConclusionThe mismatch between wants and needs of users and the expectations and requirements of a society and mental health care system based on a logic of “fixing” has contributed to distrust and stigma. Therefore, we recommend policies that increase the investment in harm reduction education and practice that target service providers, PSCSU, and society to change the context of distrust identified.

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Defining a service for people who use drugs as ‘low-threshold’: What should be the criteria?

Cited by 39 publications

References 18 publications

Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in Northern Ontario, Canada

Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in Northern Ontario, Canada

Factors associated with methadone maintenance therapy discontinuation among people who inject drugs

Harm Reduction and Tensions in Trust and Distrust in a Mental Health Service: A Qualitative Approach

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