The role of drug treatment and recovery services: an opportunity to address injection initiation assistance in Tijuana, Mexico

Substance Abuse Treatment, Prevention, and Policy

Sonia Jain¹  Xiaoying Sun¹  Patricia Gonzalez-Zuñiga²  Steffanie A. Strathdee²  Britt Skaathun²  Andrew Guise³  Dan Werb⁴  Maria Luisa Mittal⁵  Claudia Rafful⁶  Stephanie A. Meyers⁷ 

[1] Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, 92093, La Jolla, CA, USA;Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, 92093-0507, La Jolla, CA, USA;Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, 92093-0507, La Jolla, CA, USA;Addison House, Guy’s Hospital, King’s College London, Strand, WC2R 2LS, London, UK;Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, 92093-0507, La Jolla, CA, USA;Centre for Urban Health Solutions, St. Michael’s Hospital, 30 Bond Street, M5B 1W8, Toronto, ON, Canada;Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, 92093-0507, La Jolla, CA, USA;Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P, 22540, Tijuana, Baja California, Mexico;Facultad de Psicología, Universidad Nacional Autónoma de México, University City, Coyoacán, 04510, Mexico City, Mexico;Centre for Urban Health Solutions, St. Michael’s Hospital, 30 Bond Street, M5B 1W8, Toronto, ON, Canada;School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Drive, 92182, San Diego, CA, USA;Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, 92093-0507, La Jolla, CA, USA;

关键词: Medication assisted treatment;    Methadone;    Residential drug treatment;    Injection drug use;    Harm reduction;    Tijuana, Mexico;    Injection initiation;   

DOI  :  10.1186/s13011-020-00322-1

来源: Springer

【 摘 要 】

BackgroundIn 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.MethodsPReventing 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.ResultsAt 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.ConclusionTijuana’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.

【 授权许可】

CC BY