Delay among opioid users in seeking first addiction treatment

Authors

  • Carlos Ortega Muela Departamento de Salud Pública y Materno-Infantil. Facultad de Medicina. Universidad Complutense de Madrid
  • María Rodríguez Mincholé Departamento de Salud Pública y Materno-Infantil. Facultad de Medicina. Universidad Complutense de Madrid
  • Marta Donat López Escuela Nacional de Sanidad, Instituto de Salud Carlos III; CIBER Epidemiología y Salud Pública (CIBERESP)
  • Jesús Henares Montiel Escuela Andaluza de Salud Pública; CIBER Epidemiología y Salud Pública (CIBERESP)
  • Raquel García-Page Fernández Departamento de Salud Pública y Materno-Infantil. Facultad de Medicina. Universidad Complutense de Madrid
  • María José Belza Egozcue Escuela Nacional de Sanidad, Instituto de Salud Carlos III; CIBER Epidemiología y Salud Pública (CIBERESP)
  • José Pulido Manzanero Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid; CIBER Epidemiología y Salud Pública (CIBERESP)
  • Luis Sordo del Castillo Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid; CIBER Epidemiología y Salud Pública (CIBERESP)

DOI:

https://doi.org/10.20882/adicciones.1919

Keywords:

Opioids, heroin, treatment delay, new drug users, addiction.

Abstract

Early treatment seeking for opioid addiction is related to an increased chance of treatment success. New patients seeking treatment, and the time they take to seek it, have scarcely been described in Spain and Europe. The aim of the present study was to identify individual factors related to the delay in seeking treatment for opiate addiction for the first time. A cross-sectional study of opiate users admitted for the first time to treatment for addiction in public centers in the Community of Madrid between 2017-2019 (n = 366) was conducted. The time from the onset of consumption to treatment (TTT) was the dependent variable. A general descriptive analysis of users was performed, followed by a bivariate analysis after dividing the sample into two groups (TTT < 5 years and TTT ≥ 5 years). To identify those factors associated with an increase in TTT, a multivariate logistic regression analysis was performed. The main profile of the study population was: middle-aged, Spanish, unemployed, male, smoked heroin user. The median TTT was: 9.27 years for men and 4.75 for women. Factors associated with higher TTT were: > 49 years (OR: 5.87; 95%CI 1.73-20.00), unemployment (OR: 2.54; 95%CI 1.11-5.83), low educational level (OR: 2.18; 95%CI 1.04-4.59), homelessness (OR: 4.18; 95%CI 1.29-13.57), first use not at home (OR: 2.54; 95%CI 1.11-5.84) and HCV positive (OR: 2.97; 95%CI 1.00-8.82). Delays in seeking treatment are related to older users and lower sociocultural level. People at risk of social exclusion should be prioritized in interventions to facilitate their access to treatment services.

References

Bargagli, A. M., Faggiano, F., Amato, L., Salamina, G., Davoli, M., Mathis, F., Cuomo, L., Schifano, P., Burroni, P. & Perucci, C. A. (2006). VEdeTTE, a longitudinal study on effectiveness of treatments for heroin addiction in Italy: Study protocol and characteristics of study population. Substance Use & Misuse, 41(14), 1861-1879. https://doi.org/10.1080/10826080601025482.

Best, D. W., Day, E., Cantillano, V., Lopez Gaston, R., Nambamali, A., Sweeting, R. & Keaney,F. (2008). Mapping heroin careers: Utilising a standardised history-taking method to assess the speed of escalation of heroin using careers in a treatment-seeking cohort. Drug and Alcohol Review, 27(2), 165 - 170. https://doi.org/10.1080/09595230701829488.

Blanco, C., Iza, M., Rodríguez-Fernández, J. M., Baca-García, E., Wang, S. & Olfson, M. (2015). Probability and predictors of treatment-seeking for substance use disorders in the U.S. Drug and Alcohol Dependence, 149, 136-144. https://doi.org/10.1016/j.drugalcdep.2015.01.031.

Bonifonte, A. & Garcia, E. (2022). Improving geographic access to methadone clinics. Journal of Substance Abuse Treatment, 141, 108836. https://doi.org/10.1016/j.jsat.2022.108836.

Brugal, M. T., Domingo-Salvany, A., Puig, R., Barrio, G., García de Olalla, P. & de la Fuente, L. (2005). Evaluating the impact of methadone maintenance programmes on mortality due to overdose and aids in a cohort of heroin users in Spain. Addiction (Abingdon, England), 100(7), 981-989. https://doi.org/10.1111/j.1360-0443.2005.01089.x.

Cicero, T. J., Ellis, M. S., Surratt, H. L. & Kurtz, S. P. (2014). The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. JAMA Psychiatry, 71(7), 821-826. https://doi.org/10.1001/jamapsychiatry.2014.366.

Darke, S. (2011). The Life of the Heroin User: Typical Beginnings, Trajectories and Outcomes. Cambridge University Press.

Day, C. A., Ross, J., Dietze, P. & Dolan, K. (2005). Initiation to heroin injecting among heroin users in Sydney, Australia: Cross sectional survey. Harm Reduction Journal, 2(1), 2. https://doi.org/10.1186/1477-7517-2-2.

de la Fuente de Hoz, L., Brugal Puig, M. T., Ballesta Gómez, R., Bravo Poetela, M. J., Barrio Anta, G., Domingo Salvany, A., Silva, T. & Ambrós, M. (2005). [Cohort study methodology of the ITINERE Project on heroin users in three Spanish cities and main characteristics of the participants]. Revista española de salud pública, 79(4), 475-491.

de la Fuente, L., Barrio, G., Vicente, J., Bravo, M. J. & Santacreu, J. (1995). The impact of drug-related deaths on mortality among young adults in Madrid. American Journal of Public Health, 85(1), 102-105. https://doi.org/10.2105/ajph.85.1.102.

de La Fuente, L., Bravo, M. J., Barrio, G., Parras, F., Suárez, M., Rodés, A. & Noguer, I. (2003). Lessons from the history of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic among Spanish drug injectors. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 37 Suppl 5, S410-415. https://doi.org/10.1086/377562.

de la Fuente, Luis, Brugal, M. T., Domingo-Salvany, A., Bravo, M. J., Neira-León, M. & Barrio, G. (2006). [More than thirty years of illicit drugs in Spain: A bitter story with some messages for the future]. Revista española de salud pública, 80(5), 505-520. https://doi.org/10.1590/s1135-57272006000500009.

Degenhardt, L., Bharat, C., Glantz, M. D., Sampson, N. A., Al-Hamzawi, A., Alonso, J., Andrade, L., Bunting, B., Cia, A., de Girolamo, G., de Jonge, P., Demyttenaere, K., Gureje, O., Haro, J. M., Harris, M., He, Y., Hinkov, H., Nasser, A., Karam, E.,… Kessler, R. C. (2019). Association of cohort and individual substance use with risk of transitioning to drug use, drug use disorder, and remission from disorder: Findings from the World Mental Health surveys. JAMA Psychiatry, 76(7), 708-720. https://doi.org/10.1001/jamapsychiatry.2019.0163.

Farhoudian, A., Razaghi, E., Hooshyari, Z., Noroozi, A., Pilevari, A., Mokri, A., Mohammadi, M. & Malekinejad, M. (2022). Barriers and facilitators to substance use disorder treatment: An overview of systematic reviews. Substance Abuse : Research and Treatment, 16, 11782218221118462. https://doi.org/10.1177/11782218221118462.

Flórez, G., López-Durán, A., Triñanes, Y., Osorio, J., Fraga, J., Fernández, J. M. & Arrojo, M. (2015). First-time admissions for opioid treatment: Cross-sectional and descriptive study of new opioid users seeking treatment. Neuropsychiatric Disease and Treatment, 11, 2431-2440. https://doi.org/10.2147/ndt.S84431.

González-Álvarez, S., Madoz-Gúrpide, A., Parro-Torres, C., Hernández-Huerta, D. & Ochoa Mangado, E. (2019). Relationship between alcohol consumption, whether linked to other substance use or not, and antiretroviral treatment adherence in HIV+ patients. Adicciones, 31(1), 8-17. https://doi.org/10.20882/adicciones.916.

Hall, N., Le, L., Majmudar, I., Teesson, M. & Mihalopoulos, C. (2021). Treatment-seeking behaviour among people with opioid use disorder in the high-income countries: A systematic review and meta-analysis. PloS One, 16(10), e0258620. https://doi.org/10.1371/journal.pone.0258620.

Hall, N. Y., Le, L., Majmudar, I. & Mihalopoulos, C. (2021). Barriers to accessing opioid substitution treatment for opioid use disorder: A systematic review from the client perspective. Drug and Alcohol Dependence, 221, 108651. https://doi.org/10.1016/j.drugalcdep.2021.108651.

Kessler, R. C., Aguilar-Gaxiola, S., Berglund, P. A., Caraveo-Anduaga, J. J., DeWit, D. J., Greenfield, S. F., Kolody, G., Olfson, M. & Vega, W. A. (2001). Patterns and predictors of treatment seeking after onset of a substance use disorder. Archives of General Psychiatry, 58(11), 1065-1071. https://doi.org/10.1001/archpsyc.58.11.1065.

Larance, B., Gisev, N., Cama, E., Nelson, E. C., Darke, S., Larney, S. & Degenhardt, L. (2018). Predictors of transitions across stages of heroin use and dependence prior to treatment-seeking among people in treatment for opioid dependence. Drug and Alcohol Dependence, 191, 145-151. https://doi.org/10.1016/j.drugalcdep.2018.03.056.

López-Pelayo, H., Aubin, H.-J., Drummond, C., Dom, G., Pascual, F., Rehm, J., Saitz, R., Scafato, E. & Gual, A. (2020). «The post-COVID era»: Challenges in the treatment of substance use disorder (SUD) after the pandemic. BMC Medicine, 18(1), 241. https://doi.org/10.1186/s12916-020-01693-9.

Marks, K. R. & Clark, C. D. (2018). The telescoping phenomenon: Origins in gender bias and implications for contemporary scientific inquiry. Substance Use & Misuse, 53(6), 901-909. https://doi.org/10.1080/10826084.2017.1385079.

Molist, G., Brugal, M. T., Barrio, G., Mesías, B., Bosque-Prous, M., Parés-Badell, O. & de la Fuente, L. (2018). Effect of ageing and time since first heroin and cocaine use on mortality from external and natural causes in a Spanish cohort of drug users. The International Journal on Drug Policy, 53, 8-16. https://doi.org/10.1016/j.drugpo.2017.11.011.

Mowbray, O., Perron, B. E., Bohnert, A. S. B., Krentzman, A. R. & Vaughn, M. G. (2010). Service use and barriers to care among heroin users: Results from a national survey. The American Journal of Drug and Alcohol Abuse, 36(6), 305-310. https://doi.org/10.3109/00952990.2010.503824.

Mur Sierra, A. & Ortigosa Gómez, S. (2014). [Is it possible a new heroin consumption epidemic in Spain?]. Medicina clínica, 143(9), 398-400. https://doi.org/10.1016/j.medcli.2014.06.004.

Observatorio Español de las Drogas y las Adicciones (2022). Informe 2022. Alcohol, tabaco y drogas ilegales en España. Madrid: Ministerio de Sanidad. Delegación del Gobierno para el Plan Nacional sobre Drogas.

Subdirección General de Adicciones (2017). Plan de Adicciones de la ciudad de Madrid 2017-2021. Ayuntamiento de Madrid. Madrid: Madrid Salud.

Puigdollers, E., Domingo-Salvany, A., Brugal, M. T., Torrens, M., Alvarós, J., Castillo, C., Magri, N., Martin, S. & Vázquez, J. M. (2004). Characteristics of heroin addicts entering methadone maintenance treatment: Quality of life and gender. Substance Use & Misuse, 39(9), 1353-1368. https://doi.org/10.1081/ja-120039392.

Ridenour, T. A., Maldonado-Molina, M., Compton, W. M., Spitznagel, E. L. & Cottler, L. B. (2005). Factors associated with the transition from abuse to dependence among substance abusers: Implications for a measure of addictive liability. Drug and Alcohol Dependence, 80(1), 1-14. https://doi.org/10.1016/j.drugalcdep.2005.02.005.

Roy, E., Haley, N., Leclerc, P., Cédras, L. & Boivin, J. F. (2002). Drug injection among street youth: The first time. Addiction (Abingdon, England), 97(8), 1003-1009. https://doi.org/10.1046/j.1360-0443.2002.00161.x.

Salazar, A., Moreno, S., De Sola, H., Moral-Munoz, J. A., Dueñas, M. & Failde, I. (2020). The evolution of opioid-related mortality and potential years of life lost in Spain from 2008 to 2017: Differences between Spain and the United States. Current Medical Research and Opinion, 36(2), 285-291. https://doi.org/10.1080/03007995.2019.1684251.

Sánchez-Carbonell, X. & Seus, L. (2000). Ten-year survival analysis of a cohort of heroin addicts in Catalonia: The EMETYST project. Addiction (Abingdon, England), 95(6), 941-948. https://doi.org/10.1046/j.1360-0443.2000.95694110.x.

Sánchez-Niubò, A., Fortiana, J., Barrio, G., Suelves, J. M., Correa, J. F. & Domingo-Salvany, A. (2009). Problematic heroin use incidence trends in Spain. Addiction (Abingdon, England), 104(2), 248-255. https://doi.org/10.1111/j.1360-0443.2008.02451.x.

Sanvisens, A., Rivas, I., Faure, E., Muñoz, T., Rubio, M., Fuster, D., Tor, J. & Muga, R. (2014). [Characteristics of heroin dependent patients admitted to a methadone treatment program]. Medicina clínica, 142(2), 53-58. https://doi.org/10.1016/j.medcli.2012.10.023.

Shand, F. L., Degenhardt, L., Slade, T. & Nelson, E. C. (2011). Sex differences amongst dependent heroin users: Histories, clinical characteristics and predictors of other substance dependence. Addictive behaviors, 36, 27-36. https://doi.org/10.1016/j.addbeh.2010.08.008.

Stoltman, J. J. K., Woodcock, E. A., Lister, J. J., Greenwald, M. K. & Lundahl, L. H. (2015). Exploration of the telescoping effect among not-in-treatment, intensive heroin-using research volunteers. Drug and Alcohol Dependence, 148, 217-220. https://doi.org/10.1016/j.drugalcdep.2015.01.010.

Torrens, M., Domingo-Salvany, A., Alonso, J., Castillo, C. & San, L. (1999). Methadone and quality of life. Lancet (London, England), 353(9158), 1101. https://doi.org/10.1016/S0140-6736(05)76462-X.

Torrens, M., Fonseca, F., Castillo, C. & Domingo-Salvany, A. (2013). Methadone maintenance treatment in Spain: The success of a harm reduction approach. Bulletin of the World Health Organization, 91(2), 136-141. https://doi.org/10.2471/BLT.12.111054.

Valencia, J., Alvaro-Meca, A., Troya, J., Cuevas, G., Gutiérrez, J., Morro, A., Alvarez, J., Pulido, L., Cañamares, I., Escobar, I., Moreno, S. & Ryan, P. (2019). High rates of early HCV reinfection after DAA treatment in people with recent drug use attended at mobile harm reduction units. The International Journal on Drug Policy, 72, 181-188. https://doi.org/10.1016/j.drugpo.2019.06.016.

Vallejo, F., Barrio, G., Brugal, M. T., Pulido, J., Toro, C., Sordo, L., Espelt, A. & Bravo, M. J. (2015). High hepatitis C virus prevalence and incidence in a community cohort of young heroin injectors in a context of extensive harm reduction programmes. Journal of Epidemiology and Community Health, 69(6), 599-603. https://doi.org/10.1136/jech-2014-205070.

Published

2025-03-25

Issue

Section

Originals