The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #71058

Marilyn Daley, PhD, Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, MS 035, 415 South Street, Waltham, MA 02454-9110, 781-736-3906, daley@brandeis.edu, Traci Rieckmann, PhD, Department of Public Health and Preventive Medicine, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201-3098, Dennis McCarty, PhD, Department of Public Helath and Preventive Medicine, Oregon Health Sciences University, 3181 SW Samuel Jackson Park Road, Portland, OR 97201, Cindy Thomas, PhD, Brandeis University Schneider Health Policy Institute, Heller Graduate School, 415 South Street, Waltham, MA 02454, and Kathleen Keck, MMHS, University of Miami, School of Medicine, Coral Gables, FL 33124.

Despite advances in the development of medications to treat addictive disorders, they are underutilized in community-based drug treatment programs. To discover how the treatment community feels about using medication to treat heroin dependency, Brandeis and Oregon Health Sciences University surveyed clients and counselors in residential, outpatient and methadone programs in Massachusetts and Oregon. Using the Azjen-Fishbein Theory of Reasoned Action as a theoretical framework, focus groups were used to develop a questionnaire which was subsequently pilot-tested with 83 clients and 61 staff members. Questions focused on four medications (Methadone, Clonidine, Buprenorphine and Ibogaine). T-tests, Anovas and multiple regression analyses were used to identify normative influences, beliefs, expectancies, treatment settings and personal characteristics that predicted favorable or unfavorable attitudes. Although staff had become more accepting toward medication due to the increasing prevalence of dual diagnosis, the effectiveness of many medications and the spread of HIV, most clients felt that medication interfered with recovery and should only be used for withdrawal. Methadone was viewed more positively than any of the drugs, although many were guardedly optimistic about Buprenorphine's potential. Clonidine was perceived as ineffective in the treatment of heroin dependence. Counselors were more receptive to all drugs than clients. Resistance to the use of pharmacotherapy was particularly pronounced among the former heroin users in residential programs. A larger survey is underway with 1080 clients and 360 counselors. Results will be used to inform policy and practice regarding the successful adoption and implementation of effective new practices.

Learning Objectives:

• Describe at least four major medications that have been developed to treat heroin dependency
• Discuss historical barriers to adopting and implementing new pharmacotherapies in drug abuse treatment programs
• Identify the social norms, expectancies, beliefs, and values that are associated with favorable and unfavorable attitudes toward medication
• Recognize why developing and testing new medications are important for HIV prevention

Keywords: Drug Abuse Treatment, Injection Drug Users

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.