Abstract
Objective: To examine the use of social and health services by illicit opioid users outside of treatment in five Canadian cities (‘OPICAN’ cohort).
Methods: 677 eligible participants completed an interviewer-administered protocol and 584 supplied saliva samples for HIV and HCV antibody-testing. Chi-squared tests and multivariate analyses of variance (MANOVA) were carried out in order to determine the associations between use of services and specific factors. The explanatory variables of service utilization were determined with multiple regression analysis.
Results: The average age of respondents was 35 years, 66% were male and 68% were Caucasian. Women and HIV-positive individuals were more likely to receive health care. Participants who had a history of injection drug use, but had not injected within the previous 30 days, visited doctors more regularly and had a higher uptake of community-based services. Those who reported mental health problems used services less frequently than others. Participants recruited in Vancouver had more visits to needle exchange programs and centres specifically for women. Toronto participants were more likely to use homeless shelters and had a higher uptake of other types of community-based services.
Conclusion: Our study found a high rate of physical and mental health problems in illicit untreated opioid users in Canada, including the transmission of infectious disease. The availability of services seems to be a predictor of use of services. Setting up, adapting and evaluating front-line services tailored to illicit opioid users outside of treatment should be a policy and program priority.
MeSH terms: Illicit opioid use, heroin use, treatment, health services, social services, comorbidity, drug addiction, HIV, HCV
Résumé
Objectif: Étudier l’utilisation des services sociaux et de santé par des consommateurs d’opiacés illicites ne suivant pas un traitement dans cinq villes canadiennes (cohorte OPICAN).
Méthode: Les 677 participants admissibles ont répondu à un questionnaire administré par un intervieweur, et 584 ont fourni un échantillon de salive pour le sérodiagnostic du VIH et du VHC. Des analyses du khi-carré et des analyses de variance à plusieurs variables ont été réalisées pour déterminer les liens entre l’utilisation des services et les différents indicateurs. Les variables explicatives de l’utilisation des services ont été déterminées au moyen d’analyses de régression multiple.
Résultats: L’âge moyen des répondants était de 35 ans, 66 % étaient des hommes, et 68 % étaient de race blanche. Les femmes et les personnes séropositives pour le VIH étaient plus susceptibles de recevoir des soins. Les utilisateurs et utilisatrices de drogues injectables qui ne s’étaient pas injectés au cours des 30 jours précédents consultaient plus régulièrement leur médecin et faisaient plus souvent appel aux services communautaires. Ceux qui déclaraient avoir un problème de santé mentale utilisaient les services moins régulièrement. Les participants recrutés à Vancouver avaient plus souvent fait appel à des programmes d’échange de seringues et à des centres pour femmes. Les participants de Toronto étaient plus susceptibles d’utiliser les refuges pour sans-abri et avaient davantage recours aux autres types de services communautaires.
Conclusion: Notre étude révèle un taux élevé, au Canada, de problèmes de santé physique et mentale, dont la transmission de maladies infectieuses, chez les consommateurs d’opiacés illicites ne suivant pas un traitement. La disponibilité des services semble être un prédicteur de leur utilisation. L’implantation, l’adaptation et l’évaluation de services de proximité conçus pour ces clients devraient constituer une priorité dans la formulation de politiques et de programmes.
References
- 1.Palepu A, Strathdee SA, Hogg RS, Anis AH, Rae S, Cornelisse PGA, et al. The social determinants of emergency department and hospital use by injection drug users in Canada. J Urban Health. 1999;76(4):409–18. doi: 10.1007/BF02351499. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Wall R, Rehm J, Fischer B, Brands B, Gliksman L, Stewart J, et al. Social costs of untreated opioid dependence. J Urban Health. 2000;77(4):688–722. doi: 10.1007/BF02344032. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.French MT, McGeary KA, Chitwood DD, McCoy B. Chronic illicit drug use, health services utilization and the cost of medical care. Soc Sci Med. 2000;50:1703–13. doi: 10.1016/S0277-9536(99)00411-6. [DOI] [PubMed] [Google Scholar]
- 4.Laine C, Hauck W, Gourevitch M, Rothman J, Cohen A, Turner B. Regular outpatient medical and drug abuse care and subsequent hospitalization of persons who use illicit drugs. JAMA. 2001;285:2355–62. doi: 10.1001/jama.285.18.2355. [DOI] [PubMed] [Google Scholar]
- 5.Stein M. Injected-drug use: Complications and costs in the care of hospitalized HIV-infected patients. J Acquired Immune Deficiency Syndromes. 1994;7(5):469–73. [PubMed] [Google Scholar]
- 6.McGeary KA, French MT. Illicit drug use and emergency room utilization. Health Services Res. 2000;35(1PartI):153–69. [PMC free article] [PubMed] [Google Scholar]
- 7.Chitwood DD, McBride DC, French M, Comerford M. Health care need and utilization: A preliminary comparison of injection drug users, other illicit drug users and nonusers. Substance Use and Misuse. 1999;34(4&5):727–46. doi: 10.3109/10826089909037240. [DOI] [PubMed] [Google Scholar]
- 8.Palepu A, Tyndall M, Leon H, Muller J, O’Shaughnessy M, Schechter M, Anis A. Hospital utilization and costs in a cohort of injection drug users. CMAJ. 2001;165(4):415–20. [PMC free article] [PubMed] [Google Scholar]
- 9.Widman M, Platt JJ, Lidz V, Mathis DA, Metzger D. Patterns of service use and treatment involvement of methadone maintenance patients. J Substance Abuse Treatment. 1997;14(1):29–35. doi: 10.1016/S0740-5472(96)00132-8. [DOI] [PubMed] [Google Scholar]
- 10.Van Ness PH, Davis WR, Johnson BD. Socioeconomic marginality and health services utilization among central Harlem substance users. Subst Use Misuse. 2004;39(1):61–85. doi: 10.1081/JA-120027766. [DOI] [PubMed] [Google Scholar]
- 11.Knowlton AR, Hoover DR, Chung S, Celentano DD, Vlahov D, Latkin CA. Access to medical care and service utilization among injection drug users with HIV/AIDS. Drug and Alcohol Dependence. 2001;64:55–62. doi: 10.1016/S0376-8716(00)00228-3. [DOI] [PubMed] [Google Scholar]
- 12.Millson P, Myers T, Calzavara L, Wallace E, Major C, Degani N. Regional variation in HIV prevalence and risk behaviours in Ontario injection drug users (IDU) Can J Public Health. 2003;94(6):431–35. doi: 10.1007/BF03405080. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Hankins C, Alary M, Parent R, Blanchette C, Claessens C, the SurvIDU working group Continuing HIV transmission among injection drug users in eastern central Canada: The SurvUDI Study, 1995 to 2000. JAIDS. 2002;30(5):514–21. doi: 10.1097/00126334-200208150-00007. [DOI] [PubMed] [Google Scholar]
- 14.Tyndall MW, Currie S, Spittal P, Li K, Wood E, O’Shaughnessy MV, et al. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003;17(6):887–93. doi: 10.1097/00002030-200304110-00014. [DOI] [PubMed] [Google Scholar]
- 15.Health Canada. I-TRACK — Enhanced Surveillance of Risk Behaviours among Injecting Drug Users in Canada Pilot Survey Report, Surveillance and Risk Assessment Division, Centre for Disease Prevention and Control, Health Canada. 2004. p. 62. [Google Scholar]
- 16.Roy E, Alary M, Morissette C, Leclerc P, Boudreau J-F, Parent R, Rochefort J, Claessens C, and the SurvIDU Working Group. High HCV prevalence and incidence among Canadian IDUs. Int J STD & AIDS (accepted). [DOI] [PubMed]
- 17.Patrick DM, Tyndall MW, Cornelisse PGA, Li K, Sherlock CH, Rekart M, et al. Incidence of hepatitis C virus infection among injection drug users during an outbreak of HIV infection. CMAJ. 2001;165(7):889–95. [PMC free article] [PubMed] [Google Scholar]
- 18.Fischer B, Rehm J, Brissette S, Brochu S, Bruneau J, el-Guebaly N, et al. Illicit opioid use in Canada — Comparing social, health and drug use characteristics of untreated users in five cities (OPICAN Study) J Urban Health. 2005;82(2):250–66. doi: 10.1093/jurban/jti049. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Patten S. Performance of the Composite International Diagnostic Interview Short Form for major depression in community and clinical samples. Chron Dis Can. 1997;18(3):109–12. [PubMed] [Google Scholar]
- 20.Van Doornum G, Lodder A, Buimer M, van Ameijden E, Bruisten S. Evaluation of Hepatitis C antibody testing in saliva specimens collected by two different systems in comparison with HCV antibody and HCV RNA in serum. J Med Virol. 2001;64:13–20. doi: 10.1002/jmv.1011. [DOI] [PubMed] [Google Scholar]
- 21.SAS. SAS Institute Inc. Cary, NC, USA. 2001.
- 22.Latkin CA, Knowlton AR, Sherman S. Routes of drug administration, differential affiliation, and lifestyle stability among cocaine and opiate users: Implication to HIV prevention. J Substance Abuse. 2001;13:89–102. doi: 10.1016/S0899-3289(01)00070-0. [DOI] [PubMed] [Google Scholar]
- 23.Solomon L, Frank R, Vlahov D, Astemborski J. Utilization of health services in a cohort of intravenous drug users with known HIV-1 serostatus. Am J Public Health. 1991;81(10):1285–90. doi: 10.2105/AJPH.81.10.1285. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Brochu S. Drogue et criminalité. Une relation complexe. Montréal, QC: Presses de l’université de Montréal; 1995. pp. 149–70. [Google Scholar]
- 25.Booth RE, Kwiatkwoski CF, Weissman G. Health-related service and HIV risk behaviors among HIV infected injection drug users and crack smokers. Drug and Alcohol Dependence. 1999;55:69–78. doi: 10.1016/S0376-8716(98)00179-3. [DOI] [PubMed] [Google Scholar]
- 26.Fountain J, Strang J, Griffiths P, Powis B, Gossop M. Measuring met and unmet need of drug misusers: Integration of quantitative and qualitative data. Eur Addict Res. 2000;6:97–103. doi: 10.1159/000019017. [DOI] [PubMed] [Google Scholar]
- 27.Friedmann PD, D’Aunno TA, Jin L, Alexander JA. Medical and psychosocial services in drug abuse treatment: Do stronger linkages promote client utilization? Health Services Res. 2000;35(2):443–65. [PMC free article] [PubMed] [Google Scholar]