Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature
Abstract Background Syringe services programs (SSPs) provide a spectrum of health services to people who use drugs, with many providing referral and linkage to substance use disorder (SUD) treatment, and some offering co-located treatment with medications for opioid use disorder (MOUD). The objectiv...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | Addiction Science & Clinical Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13722-023-00394-x |
| _version_ | 1797806598031147008 |
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| author | Andrea Jakubowski Sabrina Fowler Aaron D. Fox |
| author_facet | Andrea Jakubowski Sabrina Fowler Aaron D. Fox |
| author_sort | Andrea Jakubowski |
| collection | DOAJ |
| description | Abstract Background Syringe services programs (SSPs) provide a spectrum of health services to people who use drugs, with many providing referral and linkage to substance use disorder (SUD) treatment, and some offering co-located treatment with medications for opioid use disorder (MOUD). The objective of this study was to review the evidence for SSPs as an entry point for SUD treatment with particular attention to co-located (onsite) MOUD. Methods We performed a scoping review of the literature on SUD treatment for SSP participants. Our initial query in PubMed led to title and abstract screening of 3587 articles, followed by full text review of 173, leading to a final total of 51 relevant articles. Most articles fell into four categories: (1) description of SSP participants’ SUD treatment utilization; (2) interventions to link SSP participants to SUD treatment; (3) post-linkage SUD treatment outcomes; (4) onsite MOUD at SSPs. Results SSP participation is associated with entering SUD treatment. Barriers to treatment entry for SSP participants include: use of stimulants, lack of health insurance, residing far from treatment programs, lack of available appointments, and work or childcare responsibilities. A small number of clinical trials demonstrate that two interventions (motivational enhancement therapy with financial incentives and strength-based case management) are effective for linking SSP participants to MOUD or any SUD treatment. SSP participants who initiate MOUD reduce their substance use, risk behaviors, and have moderate retention in treatment. An increasing number of SSPs across the United States offer onsite buprenorphine treatment, and a number of single-site studies demonstrate that patients who initiate buprenorphine treatment at SSPs reduce opioid use, risk behaviors, and have similar retention in treatment to patients in office-based treatment programs. Conclusions SSPs can successfully refer participants to SUD treatment and deliver onsite buprenorphine treatment. Future studies should explore strategies to optimize the implementation of onsite buprenorphine. Because linkage rates were suboptimal for methadone, offering onsite methadone treatment at SSPs may be an appealing solution, but would require changes in federal regulations. In tandem with continuing to develop onsite treatment capacity, funding should support evidence-based linkage interventions and increasing accessibility, availability, affordability and acceptability of SUD treatment programs. |
| first_indexed | 2024-03-13T06:09:41Z |
| format | Article |
| id | doaj.art-bd0789720ef3417d8555d1e380a4d724 |
| institution | Directory Open Access Journal |
| issn | 1940-0640 |
| language | English |
| last_indexed | 2024-03-13T06:09:41Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj.art-bd0789720ef3417d8555d1e380a4d7242023-06-11T11:21:34ZengBMCAddiction Science & Clinical Practice1940-06402023-06-0118112210.1186/s13722-023-00394-xThree decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literatureAndrea Jakubowski0Sabrina Fowler1Aaron D. Fox2Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical CenterAscension St. John HospitalDepartment of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical CenterAbstract Background Syringe services programs (SSPs) provide a spectrum of health services to people who use drugs, with many providing referral and linkage to substance use disorder (SUD) treatment, and some offering co-located treatment with medications for opioid use disorder (MOUD). The objective of this study was to review the evidence for SSPs as an entry point for SUD treatment with particular attention to co-located (onsite) MOUD. Methods We performed a scoping review of the literature on SUD treatment for SSP participants. Our initial query in PubMed led to title and abstract screening of 3587 articles, followed by full text review of 173, leading to a final total of 51 relevant articles. Most articles fell into four categories: (1) description of SSP participants’ SUD treatment utilization; (2) interventions to link SSP participants to SUD treatment; (3) post-linkage SUD treatment outcomes; (4) onsite MOUD at SSPs. Results SSP participation is associated with entering SUD treatment. Barriers to treatment entry for SSP participants include: use of stimulants, lack of health insurance, residing far from treatment programs, lack of available appointments, and work or childcare responsibilities. A small number of clinical trials demonstrate that two interventions (motivational enhancement therapy with financial incentives and strength-based case management) are effective for linking SSP participants to MOUD or any SUD treatment. SSP participants who initiate MOUD reduce their substance use, risk behaviors, and have moderate retention in treatment. An increasing number of SSPs across the United States offer onsite buprenorphine treatment, and a number of single-site studies demonstrate that patients who initiate buprenorphine treatment at SSPs reduce opioid use, risk behaviors, and have similar retention in treatment to patients in office-based treatment programs. Conclusions SSPs can successfully refer participants to SUD treatment and deliver onsite buprenorphine treatment. Future studies should explore strategies to optimize the implementation of onsite buprenorphine. Because linkage rates were suboptimal for methadone, offering onsite methadone treatment at SSPs may be an appealing solution, but would require changes in federal regulations. In tandem with continuing to develop onsite treatment capacity, funding should support evidence-based linkage interventions and increasing accessibility, availability, affordability and acceptability of SUD treatment programs.https://doi.org/10.1186/s13722-023-00394-xSyringe services programsReferral to treatmentPeople who inject drugs |
| spellingShingle | Andrea Jakubowski Sabrina Fowler Aaron D. Fox Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature Addiction Science & Clinical Practice Syringe services programs Referral to treatment People who inject drugs |
| title | Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature |
| title_full | Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature |
| title_fullStr | Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature |
| title_full_unstemmed | Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature |
| title_short | Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature |
| title_sort | three decades of research in substance use disorder treatment for syringe services program participants a scoping review of the literature |
| topic | Syringe services programs Referral to treatment People who inject drugs |
| url | https://doi.org/10.1186/s13722-023-00394-x |
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