OBJECTIVES

: An extensive body of evidence illustrates the value of integrated approaches to delivering care for those experiencing concurrent opioid use disorder (OUD) and mental illness as compared to traditional separate systems of care. Yet, less is known about the uptake of these integrated care services, or the factors that shape and facilitate access to integrated care among this population. Therefore, we sought to test an explanatory model of integrated care access among persons with concurrent OUD and mental illness.

METHODS

: Data were derived from two prospective cohorts of people who use drugs in Vancouver, Canada. The sample was restricted to those who self-reported: a proxy measure for OUD (i.e., either at least daily illicit opioid use, illicit opioid injection, or engagement in opioid agonist therapy) and diagnosed mental illness in the last six months; and reported receiving drug and mental health treatment in the last six months. Generalized estimating equations were used to examine factors associated with receiving integrated mental health and substance use treatment.

RESULTS

: Between December 2015 and November 2018, 486 participants were eligible for inclusion, 380 (78.19%) reported receiving integrated care at least once during the study period. In multivariable analysis, older age (adjusted odds ratio [AOR] = 0.98; 95% confidence interval [CI]: 0.97-0.99), male sex (AOR = 0.75; 95% CI: 0.59-0.96), daily non-injection opioid use (AOR = 0.56; 95% CI: 0.38-0.84), and experience of a recent overdose (AOR = 0.74; 95% CI: 0.58-0.95) were negatively associated with the outcome.

CONCLUSIONS

: That over three-quarters of participants reported receiving integrated care at least once during the study period may reflect changes in policy and practice to reduce silos in substance use and mental health care. Future expansion efforts should be coupled with individual and socio-structural interventions to ensure that integrated care is equally accessible to all.