Table 1:
Description of studies included in primary analyses
| Study Author, Year | Location | Total (N) | Men (n) | Women (n) | Setting | Description | OUD Definition | Inclusion / Exclusion Criteria | IDU Status | CSA-Women | CSA-Men | CPA | CEA | CPN | CEN |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Afifi et al., 2012 | USA (National) | 700 | 350 | 268 | General Population | Subset from representative population of USA adults. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)-II. | DSM-4 OUD | Excl: Institutionalised | - | 40% | 14% | 38% | 20% | 43% | 18% |
| Alexander, 2018 (Alexander et al., 2019) | Philadelphia, Pennsylvania, USA | 175 | - | 175 | OAT | Women receiving methadone with a child or pregnant enrolled in a mindfulness intervention trial. | OAT | Incl: Women with children < 3 years or pregnant | - | - | - | 30% | - | - | |
| Bailey et al., 1994 | Norco, California, USA | 354 | 354 | - | Prison | Men in the Civil Addict Program, a rehabilitation ‘alternative’ to prison for ‘narcotic addicts’. | Other treatment | Excl: LTFU 24 years after recruitment | - | - | 5% | - | - | - | - |
| Bartholomew et al., 2005 | Texas, USA (One city) | 137 | - | 137 | OAT | Women in a no-fee methadone program at a private clinic. | OAT | - | - | 39% | - | - | - | - | - |
| Blatchley et al., 2000 | Baltimore & Washington-DC, USA | 248 | - | 248 | OAT | Women in OAT with adolescent children. Children enrolled in a psycho-educational program. | OAT | Incl: Mothers with custody of children | - | 32% | - | - | - | - | - |
| SAMHSA, 2009 (From Bohnert et al., 2011) | USA (National) | 1275 | 892 | 393 | OAT, Rehabilitation | Adults surveyed as part of the National Treatment Improvement Evaluation Study (NTIES), a survey of publicly funded treatment centres in the USA | Other treatment | Incl: Admitted to treatment for heroin or ‘street’ methadone use | 75%-Ever | 22% | 5% | 36% | - | - | - |
| Browne et al., 1998 | Dublin, Ireland | 52 | 28 | 24 | OAT | Consecutive patients admitted for methadone detoxification (n=33) or OAT (n=19). Patients referred by GPs, addiction councillors, or selfreferral. | OAT | - | - | - | - | 23% | - | - | - |
| Campbell et al., 2016 | Australia (National) | 381 | 203 | 178 | Prescribed for CNCP | Subset of people with pharmaceutical opioid dependence prescribed opioids for CNCP. Recruited from community pharmacies in Australia. | ICD-10 Dependence | Excl: Only prescribed opioids for OAT or cancer pain | 38%-Ever | 46% | 22% | 43% | 55% | 17% | - |
| Cash and Wilke, 2003 | USA (National) | 336 | - | 336 | Rehabilitation, Detoxification | Subset of mothers from the DATOS study. Recruited from drug treatment programs, hospitals, and criminal justice programs. | Other treatment | Incl: Women with children | - | 27% | - | 18% | - | - | - |
| Cohen et al., 2009 | USA (Multisite) | 214 | - | 214 | OAT | Sexually active women enrolled in one of seven OAT programs participating in a national multisite clinical trial for HIV/STD interventions. | OAT | Incl: OAT > 30 days, Past 6-month HIV risk; Excl: Pregnant | - | 40% | - | - | - | - | - |
| Darke and Torok, 2013 (Darke and Torok, 2014; Torok et al., 2016) | Sydney, NSW, Australia | 300 | 201 | 99 | Harm Reduction | Subset of people who frequent needle and syringe programs and use heroin. | Frequent Illicit Use | Incl: > Weekly injecting | 100%-Current | - | - | 77% | - | - | - |
| Davis et al., 2019a | Illinois, USA | 2067 | 1373 | 694 | Rehabilitation, Detoxification | Subset of adolescents with OUD in Chestnut Health Systems, a substance use treatment provider in Illinois. | DSM-4 OUD | Incl: Adolescents only | - | 30% | 3% | 61% | 42% | - | - |
| Derefinko et al., 2019 | Tennessee, USA | 87 | 65 | 12 | OAT | Medical chart review of a rural clinic providing OAT and counselling. | OAT | - | - | - | - | - | 45% | - | 40% |
| Dissabandara et al., 2009 | Kandy, Sri Lanka | 278 | 278 | - | Prison | Male inmates in prison for drug related offenses. 98% past-month heroin use, mean use: 13 years. | Frequent Illicit Use | - | 16%-Ever | - | 7% | 22% | - | - | - |
| El-Bassel et al., 2001 (El-Bassel et al., 2000) | NYC, USA | 280 | - | 28- | OAT | Women recruited from OAT clinics in Harlem through outreach and staff referrals (1995–96). 32% sex workers | OAT | Incl: ≥ 2 HIV-risk behaviours | - | 31% | - | 38% | - | - | - |
| Engstrom et al., 2012 (El-Bassel N. et al., 2019; Engstrom et al., 2016; Panchanadeswaran et al., 2008; Rojas, 2006) | NYC, USA | 390 | - | 390 | OAT | Women recruited from OAT clinics in a sexual relationship. Subset of random sample from OAT sites in NYC. | OAT | Incl: Sexually active with men | - | 58% | - | 38% | - | - | - |
| Evans et al., 2020 (Blanco C. et al., 2020; Hassan and Le Foll, 2019) | USA (National) | 778 | 390 | 388 | General Population | Subset of participants with lifetime illicit OUD from a 2012–13 representative USA household survey (NESARC-III) | DSM-5 OUD | Excl: Institutionalised | - | 36% | 12% | 38% | 30% | 54% | 19% |
| Fudalej et al., 2015 | Warsaw, Poland | 240 | 169 | 71 | OAT | Sample of people with opioid dependence from an OAT Clinic. | ICD-10 Dependence | - | - | - | - | 24% | - | - | - |
| Gardner S.M. et al., 2020 | Columbus, Ohio, USA | 40 | 16 | 24 | Rehabilitation, Detoxification | Adolescents, young adults receiving outpatient treatment for OUD. | Any OUD | - | - | - | - | 35% | 57% | 35% | 43% |
| Garfield et al., 2017 | Melbourne, Australia | 121 | 87 | 34 | OAT, Rehabilitation, Detoxification | People receiving OAT (n=90) and recently abstinent people (n=31) from residential services. | DSM-4 Dependence | Excl: Psychosis, bipolar, major depression | - | - | 28% | 45% | 50% | 36% | 49% |
| Gilbert et al., 1997 (Gilbert et al., 2000) | NYC, USA | 151 | - | 151 | OAT | Women enrolled in OAT programs in Bronx/Harlem, recruited through staff referrals and printed announcements in 1994. | OAT | - | - | 27% | - | 39% | - | - | - |
| Golden, 2018 | Alaska, USA | 43 | - | 43 | OAT | Sample of 43 Alaskan women seeking opioid-treatment without PTSD from a dissertation. | OAT | Excl: Comorbid PTSD | - | 40% | - | 30% | 25% | - | - |
| Grella et al., 1995 | Los Angeles, California, USA | 209 | - | 209 | Snowballing, Harm Reduction | Subset of women recruited to an OAT trial by outreach and snowballing. Targeted sex workers. | OAT | Excl: LTFU (13%) | 100%-Ever | 38% | - | 40% | 57% | - | - |
| Heffernan et al., 2000 | NYC, USA | 136 | 84 | 52 | Hospital | Subset of opiate users (> daily use) from a sample of consecutive admissions to a psychiatric hospital. | Frequent Illicit Use | - | - | 27% | - | 46% | - | - | - |
| Hien et al., 2000 | Long Island, NY, USA | 96 | 47 | 49 | OAT | People at a rehabilitation centre seeking methadone for OUD. | OAT | - | - | 29% | 4% | 23% | - | - | - |
| Isralowitz et al., 2002; Isralowitz and Bar Hamburger, 2002 | Negev, Israel | 152 | 98 | 54 | OAT, Detoxification | Israeli-born patients in an outpatient drug treatment program. | OAT | - | - | 26% | 5% | 32% | - | - | - |
| Isralowitz, 2001 | Negev, Israel | 154 | 93 | 61 | OAT, Detoxification | Russia/Ukraine-born patients in an outpatient drug treatment program. | OAT, other treatment | - | - | 43% | 12% | 40% | - | - | - |
| Kaboski, 2013 | Chicago, Illinois, USA | 205 | - | 205 | OAT | Mothers of infants and pre-schoolers at one of seven public OAT clinics. | OAT | - | - | 35% | - | 33% | - | - | - |
| Kang et al., 2002 | NYC, USA | 432 | 294 | 138 | Snowballing, Harm Reduction | Participants recruited from a list of OAT treatment dropouts and by local outreach workers from 1997–1999. | OAT | Incl: Only people who left OAT | - | 48% | 31% | 60% | 58% | 66% | - |
| Khosravani et al., 2019 (Ghorbani et al., 2019) | Tehran, Iran | 350 | 350 | - | Detoxification | Men with heroin dependence at a treatment centre in Tehran (N=450). Survey 2 weeks post detoxification. | DSM-4 Heroin Dependence | Excl: Health comorbidity, refusal, women | 50%-Ever | - | - | - | 74% | - | 59% |
| Koyuncu et al., 2003 | Istanbul, Turkey | 100 | 89 | 11 | Detoxification | People with heroin dependence at an inpatient hospital detoxification centre. | DSM-4 Heroin Dependence | Excl: Comorbid psychiatric diagnosis | - | - | - | 59% | 62% | - | - |
| Kumar et al., 2016 | Little Rock, Arkansas, USA | 113 | 63 | 50 | OAT | Chart review of adults receiving buprenorphine at an outpatient clinic. | OAT | - | 27%-Ever | 16% | 18% | 19% | 25% | 23% | 18% |
| Lake et al., 2015 (Braitstein et al., 2003; Cheng et al., 2018) | Vancouver, Canada | 2393 | 1489 | 903 | Snowballing, Harm Reduction | People with a history of OAT or ≥ daily illicit opioid use from the VIDUS/ARYS/ACCESS cohorts. | OAT, Frequent Illicit Use | - | 100%-Ever | 46% | 21% | 36% | 51% | 32% | 53% |
| Lovell, 2002 | Marseille, France | 111 | 111 | - | Snowballing, Harm Reduction | People with past year IDU recruited from 3 areas in Marseille. > 82% on OAT and injecting duration 10 years. | Frequent Illicit Use | - | 100%-Ever | - | - | 18% | 15% | - | - |
| McCurdy et al., 2010 | Dar es Salaam, Tanzania | 169 | - | 169 | Snowballing, Harm Reduction | Women injected recently and had sex in the month prior. Of 559 screened, 249 remained at 5-month FU. | Frequent Illicit Use | Incl: Current IDU Excl: LTFU at 5 months (44%) | 100%-Past 2 days | 25% | - | - | - | - | - |
| Medrano et al., 1999 | San Antonio, Texas, USA | 80 | - | 80 | Snowballing, Harm Reduction | Subset of participants that primarily use opioids from women recruited to an AIDS prevention program. | Frequent Illicit Use | Excl: Past month drug treatment | 100%-Ever | 60% | - | 57% | 47% | 64% | 79% |
| Mirhashem et al., 2017 | Northern New England, USA | 84 | 45 | 39 | Snowballing, Harm Reduction | Participants with lifetime SUD, identified opioids as primary substance. 29% had received OAT. | DSM-4 OUD | Excl: Active psychosis | - | - | 27% | 51% | 49% | 58% | 49% |
| Moselhy et al., 2010 (Elhammady et al., 2014; Moselhy, 2009) | Birmingham, United Kingdom | 120 | 90 | 30 | Rehabilitation, Detoxification | Outpatient attendees at a drug treatment service without mental or SUD comorbidities. | Other treatment | Excl: Other illicit substance use, Alcohol SUD, psychosis, trauma | - | - | - | 27% | - | - | - |
| Naqavi et al., 2011 | Bardsir, Iran | 212 | 179 | 33 | Rehabilitation, Detoxification | People who visited one of four drug treatment centres | DSM-4 Dependence | - | - | - | - | - | 34% | 52% | |
| Nelson et al., 2006 | Australia (National) | 73 | 29 | 44 | General Population | Young adults from Australian Twin Register. Participants with OUD born 1964–71. Substance use resembled general population. | DSM-4 OUD | Excl: LTFU | - | 57% | - | - | - | - | - |
| Nyamathi et al., 2010 | Los Angeles, California, USA | 256 | 152 | 104 | OAT | People in OAT with moderate-heavy alcohol use at five sites promoting HAV/HBV vaccinations. | OAT | Incl: Moderateheavy alcohol use | - | - | - | 25% | - | - | - |
| Orellana et al., 2014 (Orellana, 2010) | NYC, USA | 356 | 356 | - | OAT | Males in heterosexual relationships in OAT. Parent study was a sample of males enrolled in at seven sites. | OAT | Incl: OAT > 3 months; Past year sexual partner | - | - | 34% | - | - | - | - |
| Palis et al., 2016 | Vancouver, Canada | 172 | 96 | 96 | Snowballing, Harm Reduction | Participants used opioids chronically from GeMa trial (≥5 years use, chronic use 6 months prior to survey, ≥1 OAT attempt). Recruited through snowballing and community. | OAT | Incl: ≥5 years use, ≥1 OAT attempt | 100%-Ever | 67% | 29% | 48% | 70% | 40% | 43% |
| Peles et al., 2016 (Peles et al., 2012) | Tel Aviv, Israel | 125 | 49 | 76 | OAT | People at OAT clinic and the CSA prevalence determined. Of initial group, 79 patients after LTFU. Next wave, invited all women in OAT to participate: 46 agreed. | DSM-4 OUD | Incl: Daily heroin use for ≥ 1 year Excl: LTFU (19%) | - | 89% | 24% | - | - | - | - |
| Pinto et al., 2011 | USA (Multisite) | 137 | - | 137 | Rehabilitation, Detoxification | Women with > sub-threshold PTSD from six community-based treatment sites in different US regions from Women and Trauma Study (WTS). | DSM-4 Dependence | Incl: Past 6-month substance use; DSM-4 PTSD | - | 72% | - | 59% | |||
| Plotzker et al., 2007 | Philadelphia, Pennsylvania, USA | 113 | - | 113 | Snowballing, Harm Reduction | Women recruited from two needle and syringe programs. | Frequent Illicit Use | - | 100%- Past 3 month | 56% | - | 68% | - | - | - |
| Rodriguez et al., 2017 | Tulsa, Oklahoma, USA | 48 | - | - | OAT | Receiving buprenorphine at an addiction centre medicine practice. Patients approached during regular clinic visit with their physician. | OAT | - | - | - | - | - | 52% | - | 48% |
| Rovis D. et al., 2019 | Rijeka, Croatia, Koper, Slovenia | 167 | 129 | 38 | Rehabilitation, Detoxification | Participants recruited from two in-treatment Rehab. Programs in Croatia and Slovenia. OAT (86%) | DSM-5 OUD | - | - | - | 6% | 13% | 12% | 8% | 7% |
| Sansone et al., 2009 | Dayton, Ohio, USA | 113 | 61 | 52 | Rehabilitation, Detoxification | Participants presented for admission to sub-acute detoxification 24-hr care unit that uses buprenorphine. | Other Treatment | Excl: Withdrawal or psychosis | - | - | - | 40% | 60% | 23% | - |
| Santos Goni et al., 2010 | Castilla & León, Spain | 50 | - | 50 | Rehabilitation, Detoxification | Subset of women with opiate dependence from a sample of women at 27 residential centres. | ICD-10 Dependence | Excl: Severe depression, psychosis | - | 33%* | - | 47% | 59% | - | - |
| Sartor et al., 2014 | USA (Multisite) | 3513 | 2178 | 1335 | General Population | Sub-set of clinical and general community samples of people with OUD. Recruited by family pairs from five east coast university medical schools for case-control studies. | DSM-4 Dependence | Excl: Major psychotic illness | - | 32% | 11% | 13% | - | - | - |
| Schiff et al., 2010 (Schiff et al., 2006, 2002) | Israel (Multisite) | 144 | - | 144 | OAT | Women from methadone clinics in Israel were approached for their consent to participate. | OAT | Excl: Participant, social worker refused (25%) | - | 72% | - | - | - | - | - |
| Shand et al., 2011 (Conroy et al., 2009; Larance et al., 2018; Larney et al, 2016; Maloney et al., 2010, 2009, 2007; Shand et al., 2010) | Sydney, NSW, Australia | 1513 | 914 | 599 | OAT | Participants from CATS Study were receiving OAT for heroin dependence at 34 of 35 OAT clinics in Sydney. | OAT | - | - | 71% | 36% | 62% | 53% | 37% | 61% |
| Shannon, 2007 | Lexington, Kentucky, USA | 68 | - | 68 | Rehabilitation, Detoxification | Pregnant women entered unit to receive methadone-supervised detoxification or OAT. | OAT, other treatment | Incl: Pregnant | - | 39% | - | 30% | 50% | - | - |
| Somer et al., 2010 (Somer, 2003) | Northern Israel | 149 | - | 111 | OAT, Rehabilitation, Detoxification | Receiving treatment in main heroin recovery program of northern Israel. Detoxification (n=49), outpatient treatment (n=48), OAT (n=52). | OAT | Excl: < 3 weeks in program - | - | - | 30% | 28% | - | 42% | |
| Stein et al., 2017 | Fall River, Massachusetts, USA | 457 | 326 | 131 | Rehabilitation, Detoxification | Sample of patients seeking and admitted to inpatient opioid detoxification at 24-hour medically supervised detoxification facility. | Other treatment | - | - | 42% | 11% | 36% | 48% | 18% | 42% |
| Teegen and Zumbeck, 2000 | Northern Germany | 122 | 96 | 26 | Rehabilitation, Detoxification | Participants were recruited from 10 addiction therapy facilities, all of whom use opioids. 53% in OAT. | Other treatment | - | - | - | 4% | 16% | - | - | - |
| Vogel et al., 2011 | Basel, Switzerland | 193 | 128 | 65 | OAT | People from OAT, diacetylmorphine outpatient treatment centres. | OAT | - | - | 40% | 20% | 31% | 34% | 40% | 41% |
| Walker et al., 2014 | Dallas, Texas | 72 | 25 | 47 | Rehabilitation, Detoxification | Adolescents with “cheese” heroin SUD from residential drug treatment or juvenile detention programs. | Other treatment | Excl: Psychosis, withdrawal, suicidal/homicidal ideation | 13%-Ever | 17% | - | 17% | 11% | - | - |
| Wang et al., 2010 | Shanghai, China | 341 | 123 | 218 | Rehabilitation, Detoxification | Participants were currently injecting and recruited through convenience sampling from three government operated drug rehabilitation facilities. | DSM-4 Heroin Dependence | Excl: Cardiovascular, neurological issues | 100%-Past Month | 29% | 20% | 56% | 36% | - | - |
| Weiss et al., 2019 | Tel Aviv, Israel | 51 | 33 | 18 | OAT | Patients at an OAT clinic. All clients approached (81% participation). | OAT | Incl: OAT > 3 months | 63% -Ever | - | - | 53% | - | - | - |
| Wickersham et al., 2016 | Kuala Lumpur, Malaysia | 60 | - | 60 | Snowballing, Harm Reduction | Sub-set of women in OAT recruited from community sites and shelters. | OAT | Incl: Past year other illicit substance use | - | 27% | - | 47% | - | - | - |
Table Notes: Secondary studies cited in parentheses; Abbreviations: OAT=Opioid Agonist Therapy, IDU=Injecting Drug Use, OUD=Opioid Use Disorder; CM=Childhood Maltreatment, CSA= Childhood Sexual Abuse, CPA= Childhood Physical Abuse, CEA= Childhood Emotional Abuse, CPN=Childhood Physical Neglect, CEN=Childhood Emotional Neglect, LTFU: Lost to follow-up, PTSD: posttraumatic stress disorder, Incl= Key inclusion criteria for study, Excl= Key exclusion criteria for study