Health services utilization by injection drug users participating in a needle exchange program

OBJECTIVE: To determine the characteristics associated with health care and drug treatment utilization among a distinctly high-risk sub-population of injectors participating in a needle exchange program (NEP). METHODS: Between June 1998 and May 1999, study staff collected demographic and health services utilization data on participants of the Baltimore NEP. Odds ratios and logistic regression were used to identify the participant characteristics associateds with utilizing primary health care and drug treatment during the prior 3 years. RESULTS: Among 269 participants, 81% were African-American and 66% were male. Over half (56%) had not graduated from high school, 89% were unemployed, 70% did not have health insurance, and the median age was 39 years. Fifty-eight percent of the participants reported utilizing primary care (i.e., visited a physician or other health care provider) and 44% had utilized drug treatment during the prior 3 years. Primary care utilization was associated with age > or = 39 [adjusted odds ratio (AOR) = 1.82], having health insurance (AOR = 2.16), and exchanging a higher volume of syringes per NEP visit (AOR = 2.45). Recent drug treatment utilization was associated with African-American race (AOR = 0.41), unemployment (AOR = 2.72), having health insurance (AOR = 2.05), and exchanging a higher volume of syringes per NEP visit (AOR = 0.60). CONCLUSIONS: Health insurance was significantly associated with the recent utilization of both primary care and drug treatment, yet only one-third of NEP attenders were insured. Facilitating the uptake of health insurance services at NEP sites may improve the access to health care for drug users who are currently not utilizing the health care system.