Effect of a Case Management Intervention as Part of a Needle Exchange Program on Opioid Agonist Treatment Retention

Opioid agonist treatment retention is an important predictor of abstinence, reduction in risky behavior, and overall functioning among injection drug users (IDUs). However, many studies have focused on treatment entry rather than treatment retention. In this clinical trial, investigators sought to determine the impact of a case management intervention on treatment retention among 127 needle exchange program participants referred for opioid agonist treatment. Participants were assigned to receive either a strengths-based case management (SBCM) intervention with linkage to a drug treatment program or passive referral to a drug treatment program. As part of the SBCM model, participants in the intervention group were central in formulating their own treatment goals and received assistance in achieving those goals (e.g., transportation, child care, social services). The primary outcome was retention in drug treatment.

• Median treatment duration was 7.9 months. No difference in treatment retention was observed between the intervention and control groups.
• After adjusting for intervention status and randomization,

• factors predictive of shorter treatment duration included unstable housing, buying drugs for others, living further from the treatment site, and higher levels of psychiatric distress.
• factors predictive of longer treatment retention included prior treatment history , multiple treatment requests, and being unemployed.

Comments by Tom Delaney, MSW, MPA
This study suggests environmental and social factors influence client retention in drug treatment services, which could be ameliorated through case management techniques specifically targeting these factors. It also reinforces the importance of providing substance abuse treatment as part of a comprehensive system of support including social as well as medical services.