A systematic review of interventions to increase the uptake of opiate substitution therapy in injecting drug users

BACKGROUND: Opiate substitution therapy (OST) has multiple benefits and is a key component of overdose and blood-borne virus prevention in injecting drug users (IDUs). Interventions that can increase the uptake of OST and/or re-engage people in treatment could become an important component of harm reduction. A systematic literature review was conducted for studies of interventions designed to increase the uptake of OST.

METHODS: Searches were conducted using Medline, Embase, PsycInfo and CINHAL. We concentrated on an adult population in a community setting and English language studies.

RESULTS: Eighty nine studies were identified after filtering search results, of which, 14 met the inclusion criteria. Studies were broadly categorized into motivational interventions (MI), case management (CM) or mixed approaches. Meta-analysis was performed on six studies investigating MI and two studies investigating CM interventions. Individuals exposed to MI were 1.46 times more likely to enter treatment at follow-up (95% CI: 1.14-1.86, P = 0.003) and individuals exposed to CM were 2.95 times more likely to be entering treatment at follow-up (95% CI: 2.08-4.17, P < 0.001).

CONCLUSIONS: There appears to be a promising effect for the use of both CM and MI approaches to increase the uptake of IDUs into treatment. Further investigation of these interventions is warranted.