Abstract
ObjectivesInjection drug users (IDUs) are at high risk for HIV, hepatitis, overdose and other harms. Greater drug treatment availability has been shown to reduce these harms among IDUs. Yet, little is known about changes in drug treatment availability for IDUs in the U.S. This paper investigates change in drug treatment coverage for IDUs in 90 metropolitan statistical areas (MSAs) during 1993-2002.MethodsWe define treatment coverage as the percent of IDUs who are in treatment. The number of IDUs in drug treatment is calculated from treatment entry data and treatment census data acquired from the Substance Abuse and Mental Health Service Administration, divided by our estimated number of IDUs in each MSA.ResultsTreatment coverage was low in 1993 (mean 6.7%; median 6.0%) and only increased to a mean of 8.3% and median of 8.0% coverage in 2002.ConclusionsAlthough some MSAs experienced increases in treatment coverage over time, overall levels of coverage were low. The persistence of low drug treatment coverage for IDUs represents a failure by the U.S. health care system to prevent avoidable harms and unnecessary deaths in this population. Policy makers should expand drug treatment for IDUs to reduce blood-borne infections and community harms associated with untreated injection drug use.
Highlights
The HIV/AIDS epidemic among injection drug users (IDUs) is a critically important public health issue in the United States (U.S.)
The persistence of low drug treatment coverage for IDUs represents a failure by the U.S health care system to prevent avoidable harms and unnecessary deaths in this population
Treatment has the potential to address a broad social and public health agenda valued in communities affected by IDU
Summary
The HIV/AIDS epidemic among injection drug users (IDUs) is a critically important public health issue in the United States (U.S.). IDUs are the third highest risk group for HIV infection [1]. Injection drug users experience poor health outcomes due to delayed access to effective treatment, lower adherence to care and treatment regimens, continuation of illicit drug use, depression and negative life events [11,12,13,14,15]. Milloy and colleagues [15] reported that being unable to access treatment was independently associated with recent incarceration, daily use of heroin and borrowing used syringes. Wood and colleagues [16] concluded that IDUs’ inability to access treatment was independently associated with syringe borrowing among HIV-negative IDUs at risk for HIV infection
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