Treatment Preferences for Opiate Users

Introduction: Treatment for opiate addiction is a growing demand. Rates of prescription opiate use increased between 1999 and 2010. Following the increased usage rates for prescription opiates, and the ensuing limited availability of prescription opiates, heroin use increased throughout the country. By assessing medication and non-medication assisted treatment structure, and the preferences of prescription opiate and heroin users, gaps in treatment for this population can be addressed.

Methods: A quantitative cross-sectional design was employed in Los Angeles. Convenience sampling was used to recruit a total of 100 individuals for the pilot study. Individuals over the age of 18 self-reporting using a prescription opiate in the past year were eligible to participate. Data was collection through a self-administered computer survey at a local harm reduction clinic. Descriptive statistics, chi-square and T-tests analyses were conducted.

Results:The majority of respondents (51%) were not interested in starting addiction treatment, but of those interested in treatment (22.9%) would start the same day they were surveyed.  Of the sample 31% reported trying but being unable to access treatment. The majority were unable to enter treatment because they lacked insurance or an ID (29%) or were put on a waiting list (26%).  Duration of treatment preferences varied. Of the sample (30%) preferred substance abuse treatment that lasts 1 month or less. Methadone was the preferred medically assisted treatment measure compared to Suboxone. Many participants (26%) were not familiar with Suboxone, of those familiar 35% reported they would never take Suboxone. Participants reported diverse treatment preferences, including treatment services located within needle exchanges (71%). Many individuals preferred a non-12 step treatment program (48%), same sex treatment program (31%), individual counseling sessions (87%), no group counseling (28%), access to a mental health counselor (83%) and psychiatric medications (80%). In addition, chronic body pain management was requested by the majority (81%) of the sample. Recommendations to improve treatment included access to transportation (28%), more financial resources (21%), reduced time on waitlist (16%) and later evening and weekend hours (7%).

Conclusions: While interpersonal reasons can create barriers to treatment, providers should minimize programmatic treatment barriers for opiate users. Considering the increasing need for treatment for opiate use, providers should create programs reflecting preferences for the population.  Additionally, educational campaigns about newer drugs such as Suboxone, correcting fallacies about treatment, and reducing the stigma against opiate substitution therapy can have a critical impact on long-term treatment success.