BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
Department of Family Practice, University of British Columbia, 320 - 5950 University Boulevard, Vancouver, BC, V6T 1Z6, Canada.
Subst Abuse Treat Prev Policy. 2018 Jul 5;13(1):27. doi: 10.1186/s13011-018-0164-3.
For many individuals with substance use disorders, the entry point for addiction treatment can be through withdrawal management (e.g. detoxification) services. However, little is known about the factors that predict withdrawal management service use among people who use illicit drugs (PWUD). Using data derived from two prospective cohorts of PWUD, we conducted a longitudinal data analysis of factors associated with use of withdrawal management services.
Individuals participating in two cohorts of PWUD were prospectively followed between December 2005 and May 2016 in Vancouver, Canada. Bivariate and multivariate generalized estimating equations were used to examine factors associated with use of withdrawal management services.
Out of a total of 2001 participants, 339 (16.9%) individuals reported having been to a withdrawal management centre in the previous 6 months at some point during the study period. In multivariate analyses, male sex (adjusted odds ratio [AOR]: 1.62, 95% Confidence Interval [CI]: 1.17-2.24), homelessness (AOR: 1.86, 95% CI: 1.45-2.38), binge use of any substance (AOR: 1.34, 95% CI: 1.08-1.67), having attended a supervised injection facility (AOR: 1.66, 95% CI: 1.3-2.11), and having accessed other addiction medicine treatment or supports (other than withdrawal management services or opioid agonist therapy; AOR: 3.34, 95% CI: 2.64-4.22) were positively associated with having accessed withdrawal management services, whereas older age (AOR: 0.81, 95% CI: 0.7-0.94) was negatively associated with the outcome.
This study identified specific factors associated with accessing withdrawal management services. Current evidence suggests a need to re-examine the provision of withdrawal management services. Consideration needs to be given to redesigning access to care and bridging to evidence-based addiction treatment, particularly for highly vulnerable subpopulations, identified in this study as females and older people.
对于许多患有物质使用障碍的个体来说，成瘾治疗的切入点可以是通过戒断管理（例如解毒）服务。然而，对于使用非法药物的人（PWUD），目前对于预测戒断管理服务使用的因素知之甚少。利用源自两个 PWUD 前瞻性队列的数据，我们对与戒断管理服务使用相关的因素进行了纵向数据分析。
2005 年 12 月至 2016 年 5 月期间，加拿大温哥华的两个 PWUD 队列的参与者被前瞻性随访。使用双变量和多变量广义估计方程来检查与戒断管理服务使用相关的因素。
在总共 2001 名参与者中，339 名（16.9%）个体在研究期间的某个时间点报告在过去 6 个月内去过戒断管理中心。在多变量分析中，男性（调整后的优势比 [AOR]：1.62，95%置信区间 [CI]：1.17-2.24）、无家可归（AOR：1.86，95%CI：1.45-2.38）、任何物质的狂欢使用（AOR：1.34，95%CI：1.08-1.67）、参加过监督注射设施（AOR：1.66，95%CI：1.3-2.11），以及获得其他成瘾药物治疗或支持（除戒断管理服务或阿片类激动剂治疗以外的治疗或支持；AOR：3.34，95%CI：2.64-4.22）与使用戒断管理服务呈正相关，而年龄较大（AOR：0.81，95%CI：0.7-0.94）与该结果呈负相关。
本研究确定了与使用戒断管理服务相关的具体因素。目前的证据表明，需要重新审查戒断管理服务的提供。需要考虑重新设计获得护理的途径，并将其与基于证据的成瘾治疗联系起来，特别是针对本研究中确定的高度脆弱的亚人群，即女性和老年人。
