Pilot Studies Examining Feasibility of Substance Use Disorder Screening and Treatment Linkage at Urban Sexually Transmitted Disease Clinics

Abstract

Background Sexually transmitted disease (STD) clinics provide critical public health services for screening and treatment of sexually transmitted infections throughout the US. These settings serve high-risk populations, often on a walk-in basis, and may be promising venues for integrating substance use disorder (SUD) services. Methods We report findings from two pilot studies conducted at Baltimore City Health Department’s (BCHD) STD clinics. The Screening study characterized rates of SUDs among STD clinic patients. Patients waiting for services completed a diagnostic interview mapping to DSM-5 SUD criteria (N=100). The Treatment Linkage Feasibility study examined the feasibility of linking STD clinic patients with opioid and/or cocaine use disorders to SUD treatment in the community (N=21), using SUD-focused Patient Navigation services for one month after the STD clinic visit. Assessments were conducted at baseline and 1-month follow-up. Results In the Screening study, the majority of STD clinic patients met diagnostic criteria for alcohol and/or drug SUD (57%). Substance-specific SUD rates among patients were 35% for alcohol, 31% for cannabis, 11% for opioids, and 8% for stimulants (cocaine/amphetamines). In the Treatment Linkage Feasibility study, 57% (12/21) of participants attended at least one SUD service, and 38% (8/21) were actively enrolled in SUD treatment by 1-month follow-up. The sample reported significant reductions in past 30-day cocaine use from baseline to follow-up (p=.01). Conclusions SUD rates are high among STD clinic patients. STD clinics are viable settings for initiating SUD treatment linkage services. Larger-scale research on integrating SUD services in these settings is needed.

Increased Methamphetamine, Injection Drug, and Heroin Use Among Women and Heterosexual Men with Primary and Secondary Syphilis — United States, 2013–2017

“…Pilot projects have demonstrated the feasibility and benefit of implementing substance use disorder interventions in STD clinics ( 9 , 10 ). STD programs should consider partnering with substance use disorder prevention and treatment programs and other organizations that provide services to persons who use drugs in the local community.…”

The need for sexual health clinics, their future role, and contribution to public health

“…In NYC, SHCs incorporated behavioural health and substance use counselling, and in Baltimore, Maryland, staff successfully linked patients to substance use disorder treatment services in the community. [88][89][90][91] SHCs in Baltimore, Maryland, also offer free rapid hepatitis C virus (HCV) testing with linkage and outreach support to specialty HCV care. 92 SHCs in NYC provide patients with same-day contraception initiation, with linkage to ongoing family planning as some patients may need or prefer SHCs for contraceptive care.…”

Accelerating the Pace of Science: Improving Parenting Practices in Parents with Opioid Use Disorder

“…Mothers with OUD experience heightened stress during pregnancy as they anticipate giving birth to a child with NAS/NOWS (Rizzo et al, 2014). Given that many mothers with OUD give birth to a child with NAS/NOWS, this stress may continue as the parent is confronted with difficulties with infant feeding and extended Neonatal Intensive Care Unit stays (Klaman et al, 2017). Although the stresses of parenting may exacerbate negative parenting and parental opioid use, for individuals in recovery from an OUD, parenting may serve as a protective factor for later use.…”

“…Namely, these programs reduce the incidence of preterm birth (for which preterm substance use is a risk factor), increase family economic selfsufficiency, prevent child abuse and neglect, and improve school readiness (Dawley, Loch, & Bindrich, 2007;Williams et al, 2017). These upstream prevention programs could be adapted to add components related to opioid use, including best practices for medication assisted treatment, especially during the prenatal period, and best practices for caring for children with NAS/NOW (Klaman et al, 2017).…”

“…Several reviews related to OUD and parenting have been previously conducted; one relied primarily on qualitative data (Mirick & Steenrod, 2016), and others focused on issues specifically related to medication-assisted treatment and NAS/NOWS, rather than issues affecting parenting (Klaman et al, 2017), or focused on child outcomes related to parental substance use (Morton & Wells, 2017). In the only publication to our knowledge that has systematically reviewed the literature on opioid use and parenting, Peisch et al (2018) provided an in-depth overview of the sparse literature on parenting with OUD and presented a framework for advancing research starting with basic research and ending with the creation of a research-supported intervention.…”