Participants in community-based syringe exchange programs (SEPs) engage in rates of injection drug use that exceed those reported in other populations of substance users (Wood et al., 2007). Prior work by our group has shown that a combination approach incorporating motivational and behavioral interventions is associated with increased rates of methadone treatment enrollment and reduced rates of drug use and other high risk behaviors (Kidorf &Brooner, 2006). Neverthleless, referrals from the SEP achieved worse outcomes in methadone treatment compared to those referred from other sources, including higher rates of drug use and attrition (Kidorf &Brooner, 2006). The proposed 5-year competing continuation application extends our previous work by evaluating stepped-based induction strategies to improve retention and other outcomes of syringe exchangers entering methadone treatment. Opioid-dependent Baltimore Needle Exchange (BNEP) participants (n = 520) that express interest in methadone treatment will complete a clinical assessment battery and be randomly assigned to one of three 3-month treatment induction strategies. The first is a low threshold induction (LTSC) that is broadly modeled on interim methadone maintenance (Schwartz et al., 2006) and designed to more gradually transition SEP participants to the daily structure of maintenance treatment while maximizing exposure to methadone pharmacotherapy. The second is a voucher-based intervention that uses monetary incentives to reinforce treatment engagement to schedules of methadone dosing and stepped-based counseling. The final condition (RSC) will expose participants to routine stepped-care. Participants in all conditions will receive routine stepped care during the final 3-months of participation. All participants will be stabilized on methadone (90 mg) and followed weekly for 6-months. A structured readmission intervention will be used across conditions in efforts to re-engage participants leaving treatment in the context of drug use (Brooner &Kidorf, 2002). Retention, drug use (urinalysis and self-report), and other risk behaviors are the primary outcome measures. Mediational models will evaluate the impact of changes in treatment readiness and satisfaction as predictors of outcome. These findings will inform the field on evidenced-based strategies to optimize methadone treatment effectiveness for this important subgroup of injection opioid users.

Public Health Relevance

Treatment-seeking opioid users referred from community syringe exchange programs (SEPs) have more severe drug problems and achieve worse treatment outcomes (i.e., higher rates of drug use and attrition) than individuals referred from other sources. The proposed 5-year competing continuation application evaluates two novel stepped-based induction strategies (compared to usual stepped-care) to improve retention and other outcomes in syringe exchangers entering methadone treatment.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
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Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
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Jones, Dionne
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Johns Hopkins University
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Kidorf, Michael; Brooner, Robert K; Leoutsakos, Jeannie-Marie et al. (2018) Treatment initiation strategies for syringe exchange referrals to methadone maintenance: A randomized clinical trial. Drug Alcohol Depend 187:343-350
Kidorf, Michael; Latkin, Carl; Brooner, Robert K (2016) Presence of Drug-Free Family and Friends in the Personal Social Networks of People Receiving Treatment for Opioid Use Disorder. J Subst Abuse Treat 70:87-92
Peirce, Jessica M; Schacht, Rebecca L; Brooner, Robert K et al. (2014) Prospective risk factors for traumatic event reexposure in community syringe exchange participants. Drug Alcohol Depend 138:98-102
Kidorf, Michael; King, Van L; Peirce, Jessica et al. (2013) An observation of lower rates of drug use over time in community syringe exchangers. Am J Addict 22:271-6
Peirce, Jessica M; Brooner, Robert K; Kolodner, Ken et al. (2013) Prospective effects of traumatic event re-exposure and post-traumatic stress disorder in syringe exchange participants. Addiction 108:146-53
Peirce, Jessica M; Kolodner, Ken; Brooner, Robert K et al. (2012) Traumatic event re-exposure in injecting drug users. J Urban Health 89:117-28
Kidorf, Michael; King, Van L; Gandotra, Neeraj et al. (2012) Improving treatment enrollment and re-enrollment rates of syringe exchangers: 12-month outcomes. Drug Alcohol Depend 124:162-6
Kidorf, Michael; King, Van L; Peirce, Jessica et al. (2011) A treatment reengagement intervention for syringe exchangers. J Subst Abuse Treat 41:415-21
Kidorf, Michael; King, Van L; Peirce, Jessica et al. (2011) Benefits of concurrent syringe exchange and substance abuse treatment participation. J Subst Abuse Treat 40:265-71
Kidorf, Michael; King, Van L; Peirce, Jessica et al. (2010) Psychiatric distress, risk behavior, and treatment enrollment among syringe exchange participants. Addict Behav 35:499-503

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