Substance Abuse Programs Research Articles

The effect of cognitive control on addiction relapse

Background and Aims When entering substance abuse treatment centers, some individuals with substance use disorder relapse whilst others do not. Predicting who is likely to relapse or not would enable for more effective treatment by targeting those who are at increased risk. Previous research would indicate that aspects related to cognitive control including cognitive bias, inhibitory control, and working memory may all be strong indicators of relapse likelihood. Therefore, this paper explores whether aspects of cognitive control can predict relapse likelihood. Method Participants were patients in substance treatment centers who were abstaining. They were tested on measures of cognitive bias (REsT), inhibitory control (go/no-go), and working memory (nBack). A follow-up survey was then issued after a twelve-week period to ascertain whether participants had remained abstinent or if they had relapsed. Results Relative to abstainers, individuals who relapsed had shown significant impairments in working memory and inhibitory control at baseline. They had also demonstrated increased preoccupation with substance-related stimuli as indicated by the cognitive bias measure. Conclusions These findings demonstrate that deficits in cognitive control contribute to the maintenance of substance use disorder and substance usage. The results indicate that inhibitory and working memory deficits may contribute to initial engagement in substance abuse, followed by an increase in cognitive bias and further deficits in inhibitory control and WM contributing to an increased likelihood of relapse. This suggests that decreased cognitive control may increase relapse likelihood.

Rare but Relevant: Characterizing Self-Inflicted Burn Injuries in the United States.

Self-inflicted burns (SIBs) represent a distinct entity in burn care often associated with an underlying psychiatric etiology. In this review, we summarize the existing evidence on SIBs in North America to inform targeted prevention and interventions for patients afflicted with SIBs. The following databases were queried to identify relevant articles used for literature review: PubMed, Embase, and Scopus. The main outcome measures were burn characteristics and risk factors of SIBs in the American population. A total of 14,189 patients were included across 13 included studies. The percent of total body surface area burned ranged from less than one to 100%, with a mean of 29.6 +/- 20.7%. Depressive disorders were the most reported overall; however, among mood disorders, bipolar disorder was also reported frequently, while anxiety was reported least. Motives for self-inflicting burn injury included premeditated self-injury as a coping mechanism, escape or response to delusions, impulsive self-injury, and most commonly, suicidal intention. The majority of the studies reported that pre-admission drug and alcohol abuse were associated with the occurrence of SIBs. Other identified risk factors for SIB injury included female sex, younger age, unemployment, and unmarried status. From this, it is imperative that targeted interventions are developed to address the complex interplay of psychiatric disorders, drug use, and other demographic risk factors among the American population. It is crucial for initiatives to emphasize early identification of individuals at-risk of self-harm, better access to mental health services, and stronger drug abuse programs to target SIB occurrence in the U.S..

Monitoring misuse and abuse of psychoactive substances in France: Insights from substance abuse treatment facilities through the OPPIDUM program

The OPPIDUM program was first created in 1990. It is an annual, repeated, cross-sectional, nationwide, multicenter program. Data are provided directly from users of psychoactive substances (PAS) seen in substance abuse treatment facilities. The OPPIDUM program includes sociodemographic data, data on the first PAS used and leading to dependence, data on PAS use in the week prior the interview and the modality of use. The OPPIDUM program contributes to characterize patterns of SPA use and detect changes in modalities of use or/and in users profiles. It relies on the acceptability and adhesion of the growing number of participating substance abuse treatment facilities for more than 30years, giving informative data at the national and regional level. In 2023, the OPPIDUM program gathers data from about 117,822 participants describing 239,959 patterns of PAS use (with more than 5000 participants each year). In this article, we reviewed the success of the oldest program of the French Addictovigilance Network (history, development, evolution and contribution) for the assessment and surveillance of substance abuse.

Patterns of Use and Withdrawal Syndrome in Dual Cannabis and Tobacco Users (DuCATA_GAM-CAT): Protocol for a Mixed Methods Study.

Approximately 1 in 6 cannabis users develop a cannabis use disorder (CUD) and the odds increase to 1 in 2 for daily users. The Dual use of Cannabis and Tobacco Monitoreing through a Gamified Web app (DuCATA_GAM-CaT) project aims to identify cannabis-tobacco patterns of use and withdrawal symptoms among individuals with CUD who are attending substance abuse programs. The project uses a mixed methods approach consisting of 3 studies. First, a participatory qualitative study involves focus groups comprising individuals with CUD, clinicians, project researchers, and an expert gamification company to co-design a gamified web app. Second, a longitudinal prospective study to follow up individuals over 6 weeks with CUD attending substance abuse programs . Participants report their cannabis-tobacco usage patterns, type and frequency of tobacco use, nicotine dependence, withdrawal symptoms, psychoemotional factors, and motivation to quit both substances. Predictive analysis techniques are used to analyze clinical, demographic, psychological, and environmental data to predict the probability of achieving abstinence. Third, homogeneous focus groups to explore participants' experiences during their CUD treatment. By June 2024, the project had completed the first study, defining eligible cannabis user profiles, developed the initial web app prototype, and initiated recruitment across 10 centers, with 74 participants enrolled, aiming to reach 150 participants in total. All participants are required to provide informed consent, and their information is kept confidential and anonymized following confidentiality rules. The research team is committed to disseminating the results obtained to professional and patient groups, as well as informing public health agents, to positively influence political and social decision makers and design programmers. Additionally, we aim to prioritize the publication of the results in high-impact journals specialized in drug abuse, public health, and health care services research. ClinicalTrials.gov NCT05512091; https://clinicaltrials.gov/study/NCT05512091. DERR1-10.2196/58335.

Seroprevalence and Risk Factors for Hepatitis B, Hepatitis C, and HIV in a Substance Abuse Treatment Center.

Alcohol and substance use disorders are important public health problems with an increased risk for bloodborne and sexually transmitted infections. To determine the frequency and risk factors of hepatitis B, hepatitis C and HIV in individuals with drug and alcohol addiction. This prospective study was conducted in the outpatient clinic of Alcohol and Substance Abuse Treatment and Education Center (ASATEC), Izmir, Turkey. Detailed anamneses were taken from alcohol and/or drug addicts who applied to the outpatient clinic; HBV, HCV, HIV serology results in the last 6 months were examined. The study group consisted of 478 persons, including 112 (23.4%) alcohol addicts, 322 (67.4%) substance addicts, and 44 (9.2%) combined alcohol and substance addicts. The mean age of the cases was 32 ± 11 years and 432 (90.4%) were male. Drug injection and needle sharing was recorded in 16.5% and 9.8% of participants, respectively. Hepatitis B surface antigen (HBsAg) positivity was found in 2.7%, anti-HCV positivity in 9.6% and HIV Ag/Ab positivity in 1.9% of the cases. Among patients using intravenous drugs, HBsAg positivity was found in 2%, anti-HCV positivity in 55%, while HIV Ag/Ab positivity was not detected. A history of sexually transmitted disease was a risk factor for HBsAg, HIV Ag/Ab positivity. Intravenous drug use, needle sharing and ecstasy use were determined as risk factors for anti-HCV positivity. Risky behaviors for HBV, HCV and HIV transmission are high in alcohol and substance addicts. The use of ecstasy is a novel risk factor for HCV transmission.

Patterns of Pregabalin Users from Substance Abuse Treatment Facilities: Results from the French OPPIDUM Program from 2008 to 2022.

In recent years, pregabalin has received growing attention due to its abuse liability. The aim of this study was to further characterize patterns of pregabalin users from substance abuse treatment facilities and detect changes in users profile over the study period. The data source was the Observation des Produits Psychotropes Illicites ou Détournés de leur Utilisation Médicamenteuse (OPPIDUM) program, an annual, repeated, cross-sectional, nationwide, multicenter survey that collects consumption data from patients with substance use disorders. First, we described the characteristics of pregabalin users and their consumption patterns. We compared these data between 2008 and 2018 (P1) and 2019 and 2022 (P2). Second, we conducted a multiple correspondence analysis to identify profiles of users. From 2008 to 2022, 291 pregabalin users (0.37% of all users) from 116 substance abuse treatment facilities were identified. The number of pregabalin users was lower than 15 per year in P1 (n = 89) and between 40 and 60 per year in P2 (n = 202). The number of users who reported pregabalin as the first substance leading to dependence increased significantly in P2 compared with P1 (p < 0.005). When comparing P2 with P1, there was a significant increase in precarity (p < 0.001), users in prison (p = 0.002), withdrawal symptoms (p < 0.001), dependence (p < 0.001), use of higher dose of pregabalin (p = 0.029), and acquisition by deal/street market (p < 0.001). The multiple correspondence analysis allowed for the identification of distinct profiles of pregabalin users: (i) a cluster with mainly users from P1, who presented a simple use of pregabalin, and were older (> 45 years), were involved in opioid agonist treatment (OAT), and obtained pregabalin legally; and (ii) a cluster with mainly users from P2, who presented pregabalin dependence, and were younger (< 26 years), reported pregabalin as the first substance leading to dependence, used doses higher than the market authorization, were in severe precarity, and were in prison. These data showed that the profile of pregabalin users has changed in the last years. Pregabalin use disorders also affect users without history of addiction.

Access to treatment before and after Medicare coverage of opioid treatment programs

Abstract Since January 2020, Medicare has covered opioid use disorder (OUD) treatment services at opioid treatment programs (OTPs), the only outpatient settings allowed to dispense methadone for treating OUD. This study examined policy-associated changes in Medicare acceptance and the availability of four OUD treatment services (ongoing buprenorphine, HIV/AIDS education, employment services, and comprehensive mental health assessment), by for-profit status, and county-level changes in Medicare-accepting-OTPs access, by sociodemographic characteristics (racial composition, poverty rate, and rurality). Using data from the 2019-2022 National Directory of Drug and Alcohol Abuse Treatment Facilities, we found Medicare acceptance increased from 21.31% in 2018 to 80.76% in 2021. The availability of the four treatment services increased, but no increases were significantly associated with Medicare coverage. While county-level OTP access significantly improved, counties with higher rates of non-White residents experienced an additional average increase of 0.86 Medicare-accepting-OTPs (95% CI, 0.05–1.67) compared to those without higher rates of non-White populations. Overall, Medicare coverage was associated with improved OTP access, not ancillary services.

Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers.

Hundreds of millions of dollars are spent each year by U.S. federal agencies for training and technical assistance (TTA) to be delivered by training and technical assistance centers (TTACs) to "delivery system organizations" (e.g., federally qualified health centers, state departments of health, substance abuse treatment centers, schools, and healthcare organizations). TTACs are often requested to help delivery system organizations implement evidence-based interventions. Yet, counterintuitively, TTACs are rarely required to use evidence-based approaches when supporting delivery systems (in the use of evidence-based programs). In fact, evaluations of TTAC activities tend to be minimal; evaluation of technical assistance (if conducted at all) often emphasizes outputs (number of encounters), satisfaction, and self-reports of knowledge gained-more substantive outcomes are not evaluated. The gap between (a) the volume of TTA services being funded and provided and (b) the evaluation of those services is immense and has the potential to be costly. The basic question to be answered is: how effective are TTA services? This article introduces the special issue on Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers. The special issue promotes 1) knowledge of the state of the art of evaluation of TTACs and 2) advances in what to evaluate in TTA. A major goal of the issue is to improve the science and practice of implementation support, particularly in the areas of TTA.

Effects of the mindfulness program for male substance abusers in Thailand on stress, deliberate self-harm, and drug abstinence intention: A repeated-measure design.

Substance abuse is prevalent among males, and mindfulness could serve as a means of helping individuals suffering from the adverse effects of substance abuse find relief. This study employed a one-group repeated-measure design and aimed to evaluate the effects of the mindfulness program on stress, deliberate self-harm, and drug abstinence intention among male substance abusers. The mindfulness program was implemented for Thai males with a history of narcotic drug use. Five participants were recruited from a rehabilitation institute in Thailand using convenience sampling. The program consisted of eight sessions over four weeks. The study outcomes were measured at three time points: pre-intervention (Time 1, Week 1), post-intervention (Time 2, Week 4), and follow-up (Time 3, Week 6). Research instruments included the Deliberate Self-Harm Inventory, the Perceived Stress Scale, and the Drug Abstinence Intention Questionnaire, all of which had Cronbach's alpha values above 0.80. Data analysis was carried out using the Friedman test and Dunn-Bonferroni post-hoc test. The eight-session program was implemented as intended, with a retention rate of 100%. The mean scores of deliberate self-harm and drug abstinence intention were significantly different across the three time points (χ2 = 10.000 and χ2 = 9.579, p <0.01, respectively). After conducting pairwise comparisons, the mean scores of deliberate self-harm at Time 2 and Time 3 were significantly lower than those at Time 1. Additionally, the mean scores of drug abstinence intention at Time 2 and Time 3 were higher than those at Time 1. However, the mean score of stress did not have a significant difference. This program was both acceptable and effective in reducing deliberate self-harm and improving drug abstinence intention. These findings suggest that nurses and healthcare teams involved in caring for individuals with substance abuse issues could utilize this intervention alongside other therapies or hospital treatments. Consequently, relapse prevention among substance abusers could be achieved.Thai Clinical Trials Registry Number: TCTR20230404001.

ASAM features harm reduction, methadone, OTPs at conference

Not surprisingly, last week'k American Society of Addiction Medicine (ASAM) conference was sold out, with its big focus on moving methadone out of the opioid treatment program (OTP) system and into general office‐based care (preferably by only ASAM‐boarded physicians), and also considerable attention paid to the value of high‐quality treatment with methadone. A track called “Methadone in the Modern Era” included Ruth Potee, M.D., in an impassioned speech focused on the need for more access to methadone, and on the for‐profit OTPs that are out there. That track also featured Yngvild Olsen, M.D., director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA) who talked about the other modern (aka, real world) era in which OTP regulations have been completely updated and revised. Aaron Ferguson, who said at a public conference last fall that he owed his life to diverted methadone (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33908) despite being a patient advocate, also presented at the conference, this time on harm reduction, which is beneficial to keeping people alive. Many OTPs, especially the large chain for‐profit OTPs, have been a target of ASAM members for years; most are also members of the American Association for the Treatment of Opioid Dependence, and some are members of the National Association for Behavioral Healthcare.

The effect of substance use Certificate‐of‐Need laws on access to substance use disorder treatment facilities

AbstractWe investigate how substance use Certificate‐of‐Need (CON) laws influence access to substance use disorder treatment facilities in the United States. We use the National Directory of Drug and Alcohol Abuse Treatment Facilities data set, which lists all federal, state, and local government facilities and private facilities that provide substance use treatment services in 2020. Based on the locations of these facilities, we develop a novel access index to substance use disorder treatment facilities that accounts for driving distance and duration to measure the ease of reaching these facilities for individuals living at the population‐weighted county centroids. We find that counties in states with CON laws that border counties without such laws have nearly 10% less spatial accessibility to substance use disorder treatment facilities at a 5% level of significance.

Trends in HIV-Related Services Offered by Substance Abuse Treatment Facilities.

Introduction In the United States, persons who inject drugs (PWID) represent an increasingly vulnerable population, with a high risk of HIV transmission related to needle sharing. This paper aims to investigate the availability of HIV-related services within substance abuse treatment facilities while emphasizing the need for implementing comprehensive harm-reduction strategies in such facilities. Methods This study explores the prevalence and trends regarding HIV-related services within substance abuse treatment facilities in the United States including testing, counseling, early intervention, and medication provision. Data from the National Survey of Substance Abuse Treatment Services (N-SSATS) were analyzed in order to assess trends in HIV-related services from 2013 to 2020. Results Facility response rates revealed an increase in the availability of HIV testing and specialized programs for individuals with HIV. However, there was a contrasting trend with the decline in early intervention and counseling services, only with a slight increase in 2020. Additionally, government-owned facilities demonstrated superior performance in delivering HIV services compared to private facilities. Conclusion This study highlights the dire need for implementing routine opt-out HIV testing within substance abuse treatment facilities in order to identify new cases. Additionally emphasized is the importance of early intervention for this at-risk population. To effectively address these challenges, we suggest considering the adoption of the "Seek, Test, Treat, Retain" model as a potential solution. Increasing access to HIV-related services within substance abuse facilities requires enhanced resource allocation as well as integrated programs. Identifying deficiencies in HIV service integration is crucial to enhancing care and reducing HIV transmission among PWID.

Loss to follow-up: Understand its determinants among tuberculosis patients, in Coimbra District (2005–2017)

IntroductionTuberculosis patients who abscond from treatment are more likely to contribute to ongoing transmission. This growing concern has led to the development of this study in order to assess risk factors among Tuberculosis patients lost to follow up (LTFU) notified in the Coimbra District between 2005 and 2017. Material and methodsA case-control study was designed to compare Tuberculosis patients LTFU (cases) to those successfully treated (controls). Forty-two LTFU cases were compared to 712 controls. Social and demographic data, co-morbidities, disease location, previous treatment history, drug resistance pattern and time period related to economic crisis were analyzed. In order to determine independent risk factors, numeric data was compared by one sample t-test; categorical data compared by the chi-square test or the fisher exact test, and included in a logistic regression analysis, in order to analyze their association to LTFU as a dependent variable. ResultsUnivariate analysis found that LTFU patients were more likely to be immigrants (OR:2,54; 95%CI,1,36-4,75;p < 0,01); unemployed (OR:1,99; 95%CI, 1,08-3,69;p = 0,03); civil construction workers (OR:2,53; 95%CI,1,22-5,27;p = 0,01), have a history of drug (OR:3,29; 95%CI,1,57-6,91;p < 0,01), alcohol (OR:2,16; 95%CI,1,41-3,32; p < 0,01), and tobacco abuse (OR:1,60; 95%CI,1,12-2,30; p=0,02), HIV (OR:4,15; 95%CI,2,12-8,13; p < 0,01), Hepatitis C (OR:4,51; 95%CI,1,95-10,45; p < 0,01) and Hepatitis B (OR:12,97; 95%CI,3,00–56,02; p < 0,01) virus infection. Multivariate analysis found immigrants (aOR:3,08; 95% CI, 1,20-7,93; p = 0,02) and alcohol abuse (aOR:2,81; 95% CI, 1,22-6,47; p = 0,01) to be the strongest LTFU predictor. ConclusionsLTFU likelihood was strongly associated to addictive behaviours and immigrants. It is important that the medical teams prioritize these patients for intensive follow-up care. It is recommended stronger coordination with other support services such as mental health and substance abuse programs. Multidrug-resistant tuberculosis makes necessary to highlight all of the strategies available to its prevention and management; those, should include legislative responses towards recalcitrant patients, particularly when all other less restrictive measures fail.

Drug Abuse Educational Program for Saudi University Students: A Pre-test and Post-test Design.

Background and objective Designing a consistent preventive drug abuse program and evaluating the educational needs of diverse target groups, school curricula, and new instructional materials customized to a country's socioeconomic and cultural characteristics should be used. This research aims to assess the influence of an educational program on university students' awareness of drug abuse. Methodology A cross-sectional study using a pre-test questionnaire with predetermined questions was conducted with 102 participants. The educational program about drug abuse prevention measures was subsequently implemented. After the program was completed, a post-test was administered to the students, and the results were compared to the pre-test results. The data were collected from male and female Saudi students at a university in the western area of Saudi Arabia. Results The pre-test findings indicate that the students had already received some information on drug use and abuse, but the post-test results show that their awareness rose as a result of the drug abuse educational program. Conclusion Drug abuse is a major problem all across the world, including in Saudi Arabia. However, educational programs will help to increase knowledge and awareness of this issue.

Patterns of ketamine use among people with substance use disorder in France: Multisource analysis of the data from the French Addictovigilance Network.

Due to its psychoactive effects, ketamine has become a drug used for non-medical purpose. To assess the latest trends in ketamine use among people with substance use disorder and to characterize its clinical complications using complementary health data sources of the French Addictovigilance Network. First, we extracted all reports involving ketamine from 2012 to 2021 from the database of the OPPIDUM program (i.e., a multicentric program conducted in collaboration with hundreds of substance abuse treatment facilities that collects data on drugs used by subjects with substance use disorders). We described the reports globally and the changes from 2012 to 2021. Second, we extracted all cases involving ketamine from July 2020 to December 2022 from the French National Pharmacovigilance Database (BNPV). We identified the cases related to ketamine use among people with substance use disorder and described them. There was a 2.5-fold increase in the number of ketamine users with substance use disorder in the OPPIDUM program, from 35 (0.7%) subjects in 2012 to 89 (1.7%) subjects in 2021. There was an increase in the proportion of subjects who were daily users, had distress upon discontinuation, and presented addiction. There were 238 cases related to ketamine use among people with substance use disorder in the French National Pharmacovigilance Database from July 2020 to December 2022. Among them, 94 (39.5%) cases involved ketamine use disorder, 20 (8.4%) cases involved urinary tract and kidney symptoms, and 13 (5.5%) cases involved hepatobiliary symptoms. The trend observed over 10years reflects the growth in ketamine use among people with substance use disorder, although it does not allow to estimate the rates of non-medical use of ketamine in the general population. Ketamine-induced uropathy and cholangiopathy are reported in ketamine users with substance use disorder, especially in case of repeated and/or prolonged use of high doses.

Positive Psychology Intervention (PPI) Program for Persons Who Use Drugs (PWUDS): A Pilot Study.

Building on the premises of Positive Psychology, this undertaking conducted a pilot study of the designed 14-session Positive Psychology Intervention (PPI) program established based on the character strengths and virtues (CSV) of persons who use drugs (PWUDs) to assess its usefulness, delivery details, and impacts. Conducted in one of the biggest Drug Abuse Treatment and Rehabilitation Center in the Philippines, 24 PWUDs were randomly selected by the program staff to participate in its pilot run while securing all necessary ethical guidelines and requirements. Via within-subjects pretest-posttest experimental design, the especially adapted and developed tools were used to assess the PWUDs' progress as they were facilitated by the said program. Results yielded significant improvements in the PWUDs' mental wellbeing (M = 1.29, SD = 0.35; t(21) = 9.30, P < .00001), life satisfaction (M = 1.82, SD = 0.24; t(21) = 9.89, P < .00001), and psychological functioning (M = 1.65, SD = 0.19; t(21) = 8.58, P < .00001). Moreover, the PWUDs regarded the designed PPI program very highly and experienced it with positive outcomes, especially for their CSVs. Further improvement of the said program centers around proper time allotment, number of participants in the program sessions, appropriate activities per session, including specific ice breaker games, activity materials needed, and the proper sequencing of each session. These data are used to improve the PPI program structures and components. Pertinent conclusions about the gathered data were drawn, and relevant recommendations were also thereby provided.

Relationship Between Mental Health Literacy Level and Treatment Motivation in Alcohol and Drug Addicts

The primary objective of this research is to explore how the level of Mental Health Literacy influences the motivation for treatment among individuals dealing with alcohol or substance addiction. The study involved 128 subjects undergoing inpatient treatment at the Alcohol and Substance Abuse Treatment Center. To gather data, researchers utilized a Personal Information Form, Mental Health Literacy Scale, and Treatment Motivation (TM) survey. The scores obtained from the Treatment Motivation Questionnaire and Mental Health Literacy Scale were 94.21±12.2 and 108.03±11.7, respectively. The analysis revealed a statistically significant, albeit weak, positive correlation between the participants' Mental Health Literacy Scale-Knowledge of How to Seek Mental Health Information subscale mean score and both their total Treatment Motivation Questionnaire score and their Interpersonal Help-Seeking subscale mean scores (r=0.284). Conversely, a statistically significant weak negative correlation emerged between the participants' Mental Health Literacy Scale-Knowledge of Professional Help Available subscale mean score and their Treatment Motivation Questionnaire-Distrust in Treatment subscale mean score (r=−0.230). Conclusions drawn from the study indicate that a lack of knowledge regarding addiction and accessing professional assistance, coupled with concerns surrounding stigma, pose as significant barriers to motivation for seeking treatment.

Introduction of Medicare coverage in opioid treatment programs: Findings from the first three years

BackgroundPrior to January of 2020, there was no Medicare reimbursement for services delivered in opioid treatment programs (OTPs). OTPs are the only authorized providers of opioid use disorder (OUD) treatment with methadone, a critical tool to address the opioid overdose crisis. While prior research has examined the availability of MOUD other than methadone for Medicare beneficiaries, research has not identified organizational and local Medicare beneficiary characteristics associated with Medicare insurance acceptance among OTPs. ObjectivesThis study has two objectives: 1) to determine the extent to which OTPs began accepting Medicare insurance in the first three years following the new Medicare OTP benefit; and 2) to identify organizational characteristics and local Medicare beneficiary characteristics associated with OTP acceptance of Medicare. MethodsWe used data from the 2021–2023 National Directory of Drug and Alcohol Abuse Treatment Facilities to examine OTP acceptance of Medicare. We used logistic regression to identify organizational characteristics and local Medicare beneficiary characteristics associated with OTP acceptance of Medicare (n = 4630 OTPs). ResultsBy 2022, about 78.7 % of OTPs accepted Medicare, compared to only 41.1 % of non-OTPs. The odds of Medicare acceptance were lower among for-profit OTPs, compared to non-profit OTPs, and higher among OTPs that accepted Medicaid and private insurance. Additionally, the odds of accepting Medicare were lower for OTPs located in the Northeast, Midwest, and South, compared to OTPs located in the West. Finally, the odds of accepting Medicare were higher for OTPs located in counties with higher percentages of Non-Hispanic White Medicare beneficiaries. ConclusionsWe found high rates of Medicare acceptance among OTPs in the first three years of the Medicare OTP benefit, suggesting increased access to OUD treatment via OTPs for Medicare beneficiaries. While promising, results indicate potential geographic and racial/ethnic disparities in access to OTPs.

1529. Factors Associated With HIV-positive Test Results in People Who Inject Drugs

Abstract Background Syringe Services Programs (SSP) are essential for harm reduction among persons who inject drugs (PWID). The Kentucky Income Reinvestment Program (KIRP), a statewide program funded through the Ryan White HIV/AIDS Program, provides comprehensive early intervention services targeting those at highest risk for HIV infection. As KIRP provides testing at SSPs and at other venues serving PWID, we sought to compare factors associated with a positive HIV test result between SSP sites and community testing sites. Methods We conducted a cross-sectional study across the state of Kentucky from January 2022 to March 2023. We compared the demographic characteristics of PWID tested across 54 SSPs versus PWID tested at KIRP outreach events (substance abuse treatment centers, correctional facilities, shelters, etc.); and factors associated with an HIV-positive test result. Study data were collected and managed using a REDCap database. The statistical analyses, including logistic regression, were performed with Stata 17 (College Station, TX: Stata Corp LLC). Results In the study period, 20,397 PWID were tested for HIV, 10,058 in the outreach events, and 10,339 at SSPs. The median age was 39 (IQR 32 – 46) years; 11,075 (54.3%) were male, 18,905 (92.7%) were white, and 550 (6.7%) reported MSM behavior. Outreach events were superior in reaching racial and ethnic minority groups. (Table 1). The HIV-positive rate was higher in the outreach group (0.37% vs. 0.15%; p=0.003). In a multivariate model, PWID not engaged with an SSP were significantly associated with higher HIV incidence when adjusted by gender, race, and sexual risk factors for HIV acquisition.Table 1.Demographic characteristics of the PWID tested for HIV by test location.Table 2.Factors associated with an HIV-positive test in PWID. Conclusion SSPs provide comprehensive harm reduction services, and, in our study, reduced HIV incidence amongst participants. We were able to reach more underrepresented populations with testing at outreach sites, which also serve PWID. To end the HIV epidemic, and increase prevention services, enrollment of underrepresented populations into SSP services is paramount. Disclosures All Authors: No reported disclosures

A Qualitative Study of Risk Factors of Substance Abuse among Women

Background: The rate of substance abuse by women is growing over last several decades. However, most addiction studies have been conducted on men with a quantitative approach.&#x0D; Methods: The present study examined the risk factors of addiction among women through qualitative research. This research was a content analysis. Sampling was done in a targeted manner from addicted women referred to substance abuse treatment centers in Chaharmahal and Bakhtiari province in 2022. The research tool was an in-depth interview. The research data were analyzed by open coding, axial coding, and selective coding.&#x0D; Results: The research findings showed that the main categories are individual factors, family factors, socio-cultural factors and economic factors were effective in the incidence of substance abuse among women. In terms of priority, individual factors (41%), family factors (29%), socio-cultural factors (21%) and economic factors (9%) were effective in the incidence of substance addiction among women.&#x0D; Conclusion: According to the results, it can be concluded that individual, family, socio-cultural and economic factors play a significant role in women's tendency to substance abuse. This requires providing training and solutions about these factors.&#x0D;