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THE IMPACT OF LOW THRESHOLD METHADONE PROGRAMS IN ONTARIO: AN APPROACH TO REDUCE HIV RISK BEHAVIORS AMONG OPIATE DEPENDENT DRUG USERS
Peggy Millson1, Laurel Challacombe1, Ted Myers1, Benedikt Fischer1,2, Carol Strike2, Paul Villeneuve3, Ron Shore4, Mary Pearson4, Shawn Hopkins5
1. University of Toronto, Toronto, Ontario; 2. Centre for Addiction and Mental Health, Toronto, Ontario; 3. University of Ottawa, Ottawa, Ontario; 4. Keep Six Needle Exchange Program, Kingston, Ontario; 5. The Works Needle Exchange Program, Toronto, Ontario
Objective: To evaluate the ability of low threshold methadone, delivered by needle exchange programs (NEPs), to reduce HIV risk behaviors and increase social and economic functioning among opiate users.
Methods: A low threshold program is defined as one that seeks to break down the barriers to treatment by reducing the entry and retention criteria and by allowing individuals to continue to use drugs without fear of expulsion from the program. Their main aim is not to treat the addiction but to establish and maintain contact with opiate users’ and to help stabilize and reduce some of the risks associated with drug use. Working in collaboration with two NEP low threshold methadone programs, a prospective evaluation was designed and recruitment commenced in December 2000. All new clients are approached to participate in 3 interviews over a one-year period. Recruitment will occur over a two-year period to ensure an adequate sample size estimated at 120 who have completed all three interviews. A detailed interview schedule was developed including the Addiction Severity Index, the SF-36 and a newly designed HIV risk questionnaire to evaluate changes in both needle and sexual risk behaviors. A qualitative interview was also designed for administration at 12 months postenrollment to allow for a more in depth investigation into the client’s perception of the programs. Chart reviews will provide information on HIV and hepatitis status, methadone dose and urinalysis results. Finally, pharmacies will provide documentation on missed methadone doses to evaluate any impact this may have on retention and HIV risk practices.
Results: To date 25 individuals have been recruited at the two sites. Baseline data describing characteristics of those who enter such a program will be presented.
Conclusion: Low threshold methadone programs delivered through NEPs offer an innovative approach to HIV prevention which merits further investigation.