Improving entry to methadone maintenance among
out-of-treatment injection drug users
Robert E. Booth, Ph.D.
, Karen F. Corsi, MPH, Susan K. Mikulich, Ph.D.
University of Colorado Health Sciences Center, School of Medicine, Department of Psychiatry, 1741 Vine Street, Denver, CO 80206, USA
Received 1 January 2002; received in revised form 28 February 2003; accepted 2 March 2003
This study of 577 out-of-treatment drug injectors was designed to assess predictors of methadone maintenance treatment entry, including
offering free treatment coupons. Using targeted sampling methods, participants were recruited through street outreach; randomly, they were
either assigned a coupon for 90 days of free treatment or required to pay for their treatment. Regardless of assignment, all subjects who
desired treatment were provided transportation, rapid intake, and a waiver of the treatment entry fee. Overall, 33% entered treatment,
including 66% of those who received a free coupon. Other factors associated with treatment entry included desire for treatment, heroin use,
prior treatment experience, associating with fewer drug-using friends, and injecting with a previously used unsterile needle/syringe. Injecting
cocaine and smoking crack reduced the probability of treatment entry. Findings lend support to street outreach efforts designed to increase
rates of treatment entry among chronic out-of-treatment drug injectors. Additional treatment options are required for those abusing cocaine.
D 2003 Elsevier Inc. All rights reserved.
Keywords: Treatment entry; Opiate injectors; Methadone maintenance treatment
In the United States, injection drug users (IDU) represent
the second largest risk group for HIV infection. Moreover,
the proportion of AIDS cases attributable to drug injection
has steadily increased since 1981 (Alcabes & Friedland,
1995; Centers for Disease Control, 1993, 1998, 2001).
Through December 2001, 807,075 individuals 13 years of
age or older with AIDS had been reported to the Centers for
Disease Control and Prevention (2001) by state and terri-
torial health departments. Of this total, 42% were known to
have been infected through injection drug use, including
90% among females. In the absence of a vaccine to prevent
or cure HIV, behavioral interventions are critical to control-
ling its spread. In 1997, substance abuse treatment was one
of the strategies recommended by the National Institutes of
Health Consensus Development Conference on Interven-
tions to Prevent HIV Risk Behaviors (1997). Drug treat-
ment, in particular methadone maintenance, has been shown
to be effective in reducing HIV-related risk behaviors (Ball,
Lange, Myers, & Friedman, 1988; Corsi, Kwiatkowski, &
Booth, 2002; Longshore, Hsieh, Danila, & Anglin, 1993)
and HIV seroconversion (Metzger et al., 1993; Moss et al.,
1994). Moss et al. (1994) reported that less than 12 months
of lifetime experience in methadone maintenance was a
significant risk factor for HIV seroconversion, while
Metzger et al. (1993) found a 22% seroconversion rate for
IDUs not in treatment compared to only 3.5% among those
enrolled in methadone maintenance for 18 months or longer.
Unfortunately, many IDUs do not enter treatment for
their substance abuse problem. At any given time, it is
estimated that only one in six drug users are in treatment
(Schuster, 1988). Thus, increasing the number of drug
injectors who enter treatment is important in order to impact
the spread of HIV. To achieve this goal, several strategies
have been recommended and studied. Providing rapid
intake, or treatment on demand, has been shown to be
effective in increasing treatment admissions, as well as
retention (Dennis, Ingram, Burks, & Rachael, 1994; Fes-
tinger, Lamb, Kirby, & Marlowe, 1996; Woody, O’Hare,
Mintz, & O’Brien, 1975). Lowering financial barriers
through the use of free coupons for drug treatment has also
been shown increase the number entering treatment (Bux,
0740-5472/03/$ – see front matter D 2003 Elsevier Inc. All rights reserved.
* Corresponding author. Tel.: +1-303-315-0960; fax: +1-303-316-
E-mail address: firstname.lastname@example.org (R.E. Booth).
Journal of Substance Abuse Treatment 24 (2003) 305 – 311