Methadone therapy adherence among homeless adults in a housing first trial in Vancouver, Canada
Bibliographic record
Abstract
Background Adherence to methadone substitution therapy (MST) is an important factor for successful treatment of opioid dependence. Homelessness is a known structural impediment to medication adherence, but no studies have examined MST adherence, or the effect of supported housing (e.g., Housing First [HF]), on such adherence, among homeless populations. HF includes housing with medical and social services. This study will address the following research questions: 1) What is the rate of MST adherence among homeless people? 2) What is the effect of HF on MST adherence? With a rising opioid overdose death rate in many communities around the world, such research is critical to inform MST programs and social policy for prevention. Methods Homeless adults living with mental illness were referred to the Vancouver At Home (VAH) study, as participants, by a variety of health and social services between October 2009 and June 2011. VAH is a randomized controlled trial investigating the health and social effects of HF. The medication possession ratio (MPR) was calculated to represent adherence. Administrative data were used to estimate MST adherence during the pre (the 15-year period prior to recruitment) and post-randomization period. An independent sample t-test was conducted to evaluate the two-year impact of receiving HF on MST adherence compared to treatment as usual (TAU). Results The mean MPR for MST was .47 prior to randomization and .54 during the post-randomization period. HF was not significantly associated with MST adherence (mean MPR difference between HF and TAU = .05; p=.559). Conclusions MST adherence among participants was very low and may pose increased risks for opioid overdose. Although HF did not have a significant effect on MST adherence, housing and supports are likely needed to counter the barriers homelessness creates for medication adherence. However, further interventions are needed to increase MST adherence among homeless adults experiencing mental illness. Key messages: Adherence to methadone substitution therapy is very low among homeless adults living with mental illness, and may increase the risk of opioid overdose. Housing First was not associated with adherence to methadone substitution therapy, and interventions are in urgent need to increase adherence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".