NDARC Technical Report No. 127 (2002)
Treatment for heroin dependence has a number of important benefits for both the individual and the broader community (Gowing et al., 2001). Little is currently known about heroin users’ reasons for entering and leaving treatment or barriers to treatment.
This study reports on the New South Wales arm of the Australian Prevalence and Estimation of Treatment (APET) study. The specific objectives of the NSW arm were to:
- examine the different methods used by heroin users to reduce or cease their heroin use;
- examine drug treatment utilisation of heroin users in Sydney;
- examines factors associated with having ever been in different treatment modes;
- investigate reasons for heroin users entering and leaving treatment; and
- determine barriers to entering treatment.
The study was a cross-sectional survey of heroin users in Sydney. Participants were recruited through needle and syringe programs, methadone clinics and snowballing. Those who were 16 years or older, proficient in English, used heroin at least once a month in the last six months or were in methadone maintenance treatment (MMT) were eligible to participate. All participants received $20 as contribution to travel.
Three hundred and ninety-nine participants were interviewed. They had a mean age of 31 years, 62% were male and 78% were born in Australia. Participants had used a mean of 3.5 drug classes, with heroin being the main drug used (98%) and injected (95%).
Sixty percent of the sample reported being hepatitis C positive and 56% reported a history of incarceration. Fifteen percent of participants had been administered naloxone by an ambulance officer following a heroin overdose in the preceding 12 months.
Three-hundred-and-fifty-eight (90%) participants had ever attempted to reduce their heroin use and 303 (76%) did so without help: 79% ceased any use of drugs (cold turkey); 51% self-medicated, typically with benzodiazepines and 49% moved away from the drug using scene/friends (geographical).
Formal treatment was received by 332 participants (83%). The most common treatment received was methadone maintenance treatment (65%). Other treatments received were counselling (28%), inpatient detoxification (24%), outpatient detoxification (24%), residential rehabilitation (23%) and naltrexone (including use in rapid and ultra rapid opioid detoxification 5%). After controlling for other variables, factors independently associated with having ever been in treatment were a score above four on the SDS and being hepatitis C positive.
The main reasons for entering heroin treatment were similar across the different treatment modes: wanting to stop using heroin and sick of (heroin using) lifestyle. A change of lifestyle and abstinence were the most commonly reported treatment goals. However, abstinence was achieved in fewer than half the cases for all treatment modes and MMT was the only treatment where a change of lifestyle was achieved by more than half those who identified it as a goal. The most commonly reported reason for leaving treatment was because the participants believed the treatment was not working.
The majority (57%) of participants reported being satisfied with MMT (20% reported being dissatisfied). A third (36%) reported problems with their prescriber; the most common reason being takeaway restrictions (15%), which was more likely to be reported by the current MMT group. Problems with the program were reported by 39% of participants, these included travel (19%) and opening hours (17%). Problems with methadone were reported by 45%, of which side-effects were the most commonly reported (24%). Participants reported the main changes they would like to see were MMT were reduced or no fees (33%) and more takeaway doses (29%).
A third of participants reported having sought help for heroin use but were unable to obtain any (barrier to treatment). Barriers to treatment were most commonly reported for MMT and inpatient detoxification, both of which were identified by a quarter of those who experienced barriers. The most commonly reported barrier was a lack of treatment places being available. Not being able to meet entry criteria and the cost associated with treatment were reported by a minority. Those who had previously been in treatment were more likely to report a barrier to treatment.
Heroin users seek treatment for a variety of reasons, largely associated with lifestyle changes. Reasons for seeking treatment were similar for different treatment modes. Many of the barriers to treatment reported by participants may be overcome through improved treatment service planning.