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- Title
Experiencing homelessness as a risk factor for negative treatment outcomes among individuals receiving outpatient treatment for opioid use disorder in the United States.
- Authors
Friesen, Erik Loewen; Young, Samantha
- Abstract
Introduction: people experiencing homelessness (PEH) have disproportionately high rates of opioid use disorder (OUD) and are at high risk of opioid-related morbidity and mortality. The purpose of this study was to evaluate the impact of homelessness on treatment-related outcomes among individuals receiving outpatient treatment for OUD. Methods: the data for this study came for the Treatment Episodes Data Set - Discharges (TEDS-D), a large, nationally representative discharge database for addiction treatment facilities in the United States (US). The cohort was restricted to individuals receiving outpatient treatment for OUD. Four treatment-related outcomes were explored: the use of opioid agonist therapy (OAT), treatment retention, treatment discontinuation, and treatment completion. The associations between homelessness and these four outcomes were analyzed using multivariable logistic regression models adjusted for clinically relevant covariates (age, sex, primary OUD type, psychiatric comorbidity, and polysubstance use). State-level differences in the association between homelessness and treatment outcomes were assessed and mapped. Results: 49,213 discharge records were included in the analyses. Experiencing homelessness, relative to living independently in stable housing, was associated with a lower odds of receiving OAT (adjusted odds ratio (aOR): 0.75, 95% confidence interval (CI): 0.69 - 0.80, p<0.001) and treatment retention (aOR: 0.67, 95% CI: 0.62 - 0.71, p<0.001). Homelessness had a smaller but statistically significant effect on treatment discontinuation and completion, where it increased the odds of client dropout (aOR: 1.20, 95% CI: 1.11 - 1.29, p<0.001) and decreased the odds of completion (aOR: 0.84, 95% CI: 0.78 - 0.92, p<0.001). The associations between homelessness and OAT use and homelessness and retention varied substantially between states. Conclusion: in this large, US cohort of individuals receiving outpatient treatment for OUD, experiencing homelessness was associated with worse treatment outcomes than clients who were stably housed. Further research into the specific barriers to OAT and engagement in treatment for PEH are needed to target interventions to improve OUD treatment outcomes for this population that already faces numerous forms of structural marginalization associated with poorer health outcomes.
- Subjects
UNITED States; SUBSTANCE abuse treatment; SUBSTANCE abuse; NARCOTICS; NARCOTIC antagonists; ACQUISITION of data methodology; CONFIDENCE intervals; ANALGESICS; MULTIPLE regression analysis; MULTIVARIATE analysis; TREATMENT duration; TREATMENT effectiveness; PSYCHOSOCIAL factors; MEDICAL records; DESCRIPTIVE statistics; HOMELESS persons; HOMELESSNESS; ODDS ratio; TERMINATION of treatment; OUTPATIENT services in hospitals; LONGITUDINAL method; EVALUATION
- Publication
University of Toronto Medical Journal, 2021, Vol 98, Issue 2, p56
- ISSN
0833-2207
- Publication type
Article