Use of withdrawal management services among people who use illicit drugs in Vancouver, Canada

Sharon Vipler,Ekaterina Nosova,Lianping Ti,Thomas Kerr,Evan Wood,M.-J Milloy,Kanna Hayashi

doi:10.1186/s13011-018-0164-3

Abstract

BackgroundFor many individuals with substance use disorders, the entry point for addiction treatment can be through withdrawal management (e.g. detoxification) services. However, little is known about the factors that predict withdrawal management service use among people who use illicit drugs (PWUD). Using data derived from two prospective cohorts of PWUD, we conducted a longitudinal data analysis of factors associated with use of withdrawal management services.MethodsIndividuals participating in two cohorts of PWUD were prospectively followed between December 2005 and May 2016 in Vancouver, Canada. Bivariate and multivariate generalized estimating equations were used to examine factors associated with use of withdrawal management services.ResultsOut of a total of 2001 participants, 339 (16.9%) individuals reported having been to a withdrawal management centre in the previous 6 months at some point during the study period. In multivariate analyses, male sex (adjusted odds ratio [AOR]: 1.62, 95% Confidence Interval [CI]: 1.17–2.24), homelessness (AOR: 1.86, 95% CI: 1.45–2.38), binge use of any substance (AOR: 1.34, 95% CI: 1.08–1.67), having attended a supervised injection facility (AOR: 1.66, 95% CI: 1.3–2.11), and having accessed other addiction medicine treatment or supports (other than withdrawal management services or opioid agonist therapy; AOR: 3.34, 95% CI: 2.64–4.22) were positively associated with having accessed withdrawal management services, whereas older age (AOR: 0.81, 95% CI: 0.7–0.94) was negatively associated with the outcome.ConclusionsThis study identified specific factors associated with accessing withdrawal management services. Current evidence suggests a need to re-examine the provision of withdrawal management services. Consideration needs to be given to redesigning access to care and bridging to evidence-based addiction treatment, particularly for highly vulnerable subpopulations, identified in this study as females and older people.

Highlights

For many individuals with substance use disorders, the entry point for addiction treatment can be through withdrawal management services
The present study found that only 17% of participants in the study accessed withdrawal management services over a median of 78.8 months of follow-up
We found that men were 62% more likely to have accessed withdrawal management services, which aligns with published literature that women who use substances have traditionally faced additional barriers to accessing addiction treatment in comparison to men

Summary

Introduction

For many individuals with substance use disorders, the entry point for addiction treatment can be through withdrawal management (e.g. detoxification) services. Little is known about the factors that predict withdrawal management service use among people who use illicit drugs (PWUD). Withdrawal management facilities (previously more commonly referred to as detoxification centres) can be the first point of contact for individuals seeking assistance in the management of their substance use disorders. For many individuals, it is a vital first step in connecting patients to more definitive treatment options, including but not restricted to opioid agonist therapy and alcohol relapse prevention medications [11]. Medical withdrawal management facilities can initiate definitive management in the form of agonist therapy (opioid use disorder) or relapse prevention medications (alcohol use disorders) [15]. Individuals will be transferred from acute care hospitals to withdrawal management facilities

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Discussion

Conclusion