Methadone maintenance and cessation of injecting drug use: results from the Amsterdam Cohort Study

Langendam, Miranda; Brussel, G. H. A. Van; Coutinho, Roel A.; Ameijden, E. J. C. Van

doi:10.1046/j.1360-0443.2000.95459110.x

Cited by 71 publications

(43 citation statements)

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“…9,10 These studies show that younger age, stable housing, employment, HIV seropositivity, abstinence from alcohol, having a lower frequency of injecting, and not having a PWID sex partner are all predictive of cessation of injection drug use. 7,8,[11][12][13][14] Aside from these factors, having depressive symptoms, a history of incarceration or involvement in illicit or marginal activities, such as sex work, or having a partner involved in illegal activities lowers the likelihood of stopping injection drug use. 7,10,11,15,16 Some of these characteristics also predict relapse: younger age, homelessness, HIV seropositivity, use of alcohol, and sexual abstinence are associated with a shorter time to injection relapse.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities

et al. 2015

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We know little about predictors of injection drug cessation and relapse among female sex workers who inject drugs (FSW-PWID) at the US-Mexico border. Among HIV-negative FSW-PWID taking part in a behavioral intervention study in Tijuana and Ciudad Juárez, Cox regression was used to identify predictors of time to first cessation of injection, which was defined as reporting not having injected drugs for a period of 4 months or longer, and among that subset, we examined predictors of time to injection relapse. Among 440 women, 84 (19 %) reported ceasing injection during follow-up (median time to cessation = 9.3 months); of these, 30 (35 %) reported relapse to injection (median time to relapse = 3.5 months). The rate of injection cessation was lower for women reporting trading sex prior to age 18 (adj. hazard ratio (HR) = 0.64, 95 % confidence interval (CI) = 0.41-1.01), ever being sexually abused (adj. HR = 0.44, 95 % CI = 0.27-0.71), and a higher number of vaginal sex acts with casual clients (adj. HR = 0.99 per transaction, 95 % CI = 0.98-1.00). The rate of cessation was higher for women who spent more hours on the streets on a typical day (adj. HR = 1.04/h, 95 % CI = 1.01-1.08) and who lived in Tijuana vs. Ciudad Juárez (adj. HR = 2.15, 95 % CI = 1.14-4.07). The rate of relapse was higher among women reporting regular drug use with clients (adj. HR = 2.17, 95 % CI = 0.96-4.89) and those scoring higher on a risk injection index (adj. HR = 2.04, 95 % CI = 1.15-3.61). The rate of relapse was lower for FSW-PWID with higher than average incomes (adj. HR = 0.40, 95 % CI = 0.18-0.89). These findings have important implications for the scale-up of methadone maintenance treatment programs (MMTPs) in Mexico and indicate a need for gender-specific programs that address sexual abuse experiences and economic vulnerabilities faced by FSW-PWID.

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Section: Introductionmentioning

confidence: 99%

Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities

et al. 2015

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“…Treating drug addiction is one of the most effective ways to reduce costs associated with drug use (National Institutes on Drug Abuse, 1999). In addition to reducing drug use, participation in drug treatment programs also reduces the risk of infection with HIV and hepatitis (Langendam et al 2000;Metzger et al 1998). Both longitudinal and crosssectional studies demonstrate that those who participate in drug treatment, compared to those who do not, and those who stay longer in treatment programs compared to those who stop attending treatment, have lower seroconversion rates for infections and report engaging in less high-risk sexual and injecting behaviors (Hartel and Schoenbaum, 1998;Magura et al 1998;Stark et al 1996).…”

Section: Introductionmentioning

confidence: 99%

Individual and Social Factors Associated With Participation in Treatment Programs for Drug Users

Gyarmathy

Latkin

2008

Substance Use & Misuse

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Since only about one third of people who are dependent on drugs are in treatment, there is a need to promote both treatment entry and retention. Previous research has described the role of individual and social characteristics in drug treatment participation, but little is known about the interaction of individual and social factors. Injecting and non-injecting drug users (2002-2004; N=581) were recruited in Baltimore, MD (SHIELD Study) and were administered a structured questionnaire. The mean age of participants was 43.6 years, 41% were female, 50% had high school education, and 16% self-reported being HIV infected. Logistic regression analyses of interaction terms revealed that compared to those with no plans to stop and no friends encouraging them to enter treatment those who planned to cease drug use or whose friends encouraged treatment were more likely to attend a 12-step program. Furthermore, compared to those with no problems with drug use and no friends encouraging them to enter treatment those with greater perceived drug problem severity or with friends encouraging treatment were more likely to attend methadone maintenance, as were those who did not receive free drugs from others. The influence of friends may have a crucial modifying effect by getting into treatment less addicted individuals who have higher chances of successful recovery.

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“…To ensure valid and detailed assessment of methadone treatment, we linked data from a large cohort of drug users with data from the Amsterdam Central Methadone Register. The present study was part of a project evaluating harm-reduction-based methadone treatment in relation to HIV infection 18,21,22 and mortality.…”

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The impact of harm-reduction-based methadone treatment on mortality among heroin users

Langendam

Brussel²,

Coutinho³

et al. 2001

Am J Public Health

128

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OBJECTIVES: The purpose of this study was to investigate the impact of harm-reduction-based methadone programs on mortality among heroin users. METHODS: A prospective cohort investigation was conducted among 827 participants in the Amsterdam Cohort Study. Poisson regression was used to identify methadone maintenance treatment characteristics (dosage, frequency of program attendance, and type of program) that are significantly and independently associated with mortality due to natural causes and overdose. RESULTS: From 1985 to 1996, 89 participants died of natural causes, and 31 died as a result of an overdose. After adjustment for HIV and underweight status, there was an increase in natural-cause mortality among subjects who left methadone treatment (relative risk [RR] = 2.38, 95% confidence interval [CI] = 1.28, 4.55). Leaving treatment was also related to higher overdose mortality, but only among injection drug users (RR = 4.55, 95% CI = 1.89, 10.00). CONCLUSIONS: Harm-reduction-based methadone treatment, in which the use of illicit drugs is tolerated, is strongly related to decreased mortality from natural causes and from overdoses. Provision of methadone in itself, together with social-medical care, appears more important than the actual methadone dosage.

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Methadone maintenance and cessation of injecting drug use: results from the Amsterdam Cohort Study

Abstract: Steadily increasing the methadone dosage in a harm reduction setting may be useful in supporting injecting drug users in the process of cessation of injecting and reducing the spread of HIV-infection.

Cited by 71 publications

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Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities

Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities

Individual and Social Factors Associated With Participation in Treatment Programs for Drug Users

The impact of harm-reduction-based methadone treatment on mortality among heroin users

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