TY - JOUR
T1 - The role of drug treatment and recovery services
T2 - an opportunity to address injection initiation assistance in Tijuana, Mexico
AU - Meyers, Stephanie A
AU - Rafful, Claudia
AU - Jain, Sonia
AU - Sun, Xiaoying
AU - Skaathun, Britt
AU - Guise, Andrew
AU - Gonzalez-Zuñiga, Patricia
AU - Strathdee, Steffanie A
AU - Werb, Dan
AU - Mittal, Maria Luisa
N1 - Funding Information:
PRIMER and Dan Werb were supported by a US National Institute on Drug Abuse (NIDA) Avenir Award (DP2-DA040256–01), the Canadian Institutes of Health Research (CIHR) via a New Investigator Award, and the Ontario Ministry of Research, Innovation and Science via an Early Researcher Award. El Cuete IV and Steffanie Strathdee were supported through NIDA grant R37 DA019829. Stephanie Meyers was supported through NIDA grant R01 DA039950. Maria Luisa Mittal was supported by UC San Diego Center for AIDS Research NIAID P30AI36214 and NIDA grants T32DA023356 and 3R01DA040648-02S1. Claudia Rafful was supported by a UC-MEXUS/CONA-CyT scholarship grant 209407/313533, UC MEXUS Dissertation Grant DI 15– 42 and the CIHR Postdoctoral Research Fellowship. Britt Skaathun was supported by UC San Diego Center for AIDS Research NIAID P30 AI036214.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/10/12
Y1 - 2020/10/12
N2 - BACKGROUND: In the U.S. and Canada, people who inject drugs' (PWID) enrollment in medication-assisted treatment (MAT) has been associated with a reduced likelihood that they will assist others in injection initiation events. We aimed to qualitatively explore PWID's experiences with MAT and other drug treatment and related recovery services in Tijuana Mexico, a resource-limited setting disproportionately impacted by injection drug use.METHODS: PReventing Injecting by Modifying Existing Responses (PRIMER) seeks to assess socio-structural factors associated with PWID provision of injection initiation assistance. This analysis drew on qualitative data from Proyecto El Cuete (ECIV), a Tijuana-based PRIMER-linked cohort study. In-depth qualitative interviews were conducted with a subset of study participants to further explore experiences with MAT and other drug treatment services. Qualitative thematic analyses examined experiences with these services, including MAT enrollment, and related experiences with injection initiation assistance provision.RESULTS: At PRIMER baseline, 607(81.1%) out of 748 participants reported recent daily IDU, 41(5.5%) reported recent injection initiation assistance, 92(12.3%) reported any recent drug treatment or recovery service access, and 21(2.8%) reported recent MAT enrollment (i.e., methadone). Qualitative analysis (n = 21; female = 8) revealed that, overall, abstinence-based recovery services did not meet participants' recovery goals, with substance use-related social connections in these contexts potentially shaping injection initiation assistance. Themes also highlighted individual-level (i.e., ambivalence and MAT-related stigma) and structural-level (i.e., cost and availability) barriers to MAT enrollment.CONCLUSION: Tijuana's abstinence-based drug treatment and recovery services were viewed as unable to meet participants' recovery-related goals, which could be limiting the potential benefits of these services. Drug treatment and recovery services, including MAT, need to be modified to improve accessibility and benefits, like preventing transitions into drug injecting, for PWID.
AB - BACKGROUND: In the U.S. and Canada, people who inject drugs' (PWID) enrollment in medication-assisted treatment (MAT) has been associated with a reduced likelihood that they will assist others in injection initiation events. We aimed to qualitatively explore PWID's experiences with MAT and other drug treatment and related recovery services in Tijuana Mexico, a resource-limited setting disproportionately impacted by injection drug use.METHODS: PReventing Injecting by Modifying Existing Responses (PRIMER) seeks to assess socio-structural factors associated with PWID provision of injection initiation assistance. This analysis drew on qualitative data from Proyecto El Cuete (ECIV), a Tijuana-based PRIMER-linked cohort study. In-depth qualitative interviews were conducted with a subset of study participants to further explore experiences with MAT and other drug treatment services. Qualitative thematic analyses examined experiences with these services, including MAT enrollment, and related experiences with injection initiation assistance provision.RESULTS: At PRIMER baseline, 607(81.1%) out of 748 participants reported recent daily IDU, 41(5.5%) reported recent injection initiation assistance, 92(12.3%) reported any recent drug treatment or recovery service access, and 21(2.8%) reported recent MAT enrollment (i.e., methadone). Qualitative analysis (n = 21; female = 8) revealed that, overall, abstinence-based recovery services did not meet participants' recovery goals, with substance use-related social connections in these contexts potentially shaping injection initiation assistance. Themes also highlighted individual-level (i.e., ambivalence and MAT-related stigma) and structural-level (i.e., cost and availability) barriers to MAT enrollment.CONCLUSION: Tijuana's abstinence-based drug treatment and recovery services were viewed as unable to meet participants' recovery-related goals, which could be limiting the potential benefits of these services. Drug treatment and recovery services, including MAT, need to be modified to improve accessibility and benefits, like preventing transitions into drug injecting, for PWID.
KW - Harm reduction
KW - Injection drug use
KW - Injection initiation
KW - Medication assisted treatment
KW - Methadone
KW - Mexico
KW - Residential drug treatment
KW - Tijuana
UR - http://www.scopus.com/inward/record.url?scp=85092510305&partnerID=8YFLogxK
U2 - 10.1186/s13011-020-00322-1
DO - 10.1186/s13011-020-00322-1
M3 - Article
C2 - 33046125
SN - 1747-597X
VL - 15
SP - 78
JO - Substance abuse treatment prevention and policy
JF - Substance abuse treatment prevention and policy
IS - 1
M1 - 78
ER -
