Dataset Information

Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publicly-funded facilities in California, USA: 1991-2012.

ABSTRACT: California treats the largest population of opioid dependent individuals in the USA and is among a small group of states that applies regulations for opioid treatment that are more stringent than existing federal regulations. We aim to characterize changes in patient characteristics and treatment utilization over time, and identify determinants of successful completion of detoxification and MMT retention in repeated attempts.State-wide administrative data was obtained from California Outcome Measurement System during the period: January 1st, 1991-March 31st, 2012. Short-term detoxification treatment and long-term maintenance treatment, primarily with methadone, was available to study participants. Mixed effects regression models were used to define determinants of successful completion of the detoxification treatment protocol (as classified by treatment staff) and duration of maintenance treatment.The study sample consisted of 237,709 unique individuals and 885,971 treatment episodes; 837% were detoxification treatment episodes in 1994, dropping to 40.5% in 2010. Among individuals accessing only detoxification, the adjusted odds of success declined with each successive attempt (vs. 1st attempt: 2nd: OR: 0.679; 95% CI (0.610, 0.755); 3rd: 0.557 (0.484, 0.641); 4th: 0.526 (0.445, 0.622); 5th: 0.407 (0.334, 0.497); ?6th: 0.339 (0.288, 0.399). For those ever accessing maintenance treatment, later subsequent attempts were longer in duration, and those with two or more prior attempts at detoxification had marginally longer subsequent maintenance episodes (hazard ratio: 0.97; 95% CI: 0.95, 0.99). Finally, only 10.9% of all detoxification episodes were followed by admission into maintenance treatment within 14 days.This study has revealed high rates of detoxification treatment for opioid dependence in California throughout the study period, and decreasing odds of success in repeated attempts at detoxification.

SUBMITTER: Nosyk B

PROVIDER: S-EPMC4484858 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publicly-funded facilities in California, USA: 1991-2012.

Nosyk Bohdan B Li Libo L Evans Elizabeth E Urada Darren D Huang David D Wood Evan E Rawson Richard R Hser Yih-Ing YI

Drug and alcohol dependence 20140727

<h4>Background</h4>California treats the largest population of opioid dependent individuals in the USA and is among a small group of states that applies regulations for opioid treatment that are more stringent than existing federal regulations. We aim to characterize changes in patient characteristics and treatment utilization over time, and identify determinants of successful completion of detoxification and MMT retention in repeated attempts.<h4>Methods</h4>State-wide administrative data was o ...[more]

PMID: 25110333

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Project description:Treatment for opioid use disorders (OUD) reduces the risk of mortality and infectious disease transmission; however, opportunities to quantify the potential economic benefits of associated decreases in drug-related crime are scarce. This paper aimed to estimate the costs of crime during and after periods of engagement in publicly funded treatment for OUD to compare total costs of crime during a hypothetical 6-month period following initiation of opioid agonist treatment (OAT) versus detoxification.Retrospective, administrative data-based cohort study with comprehensive information on drug treatment and criminal justice systems interactions.Publicly funded drug treatment facilities in California, USA (2006-10).A total of 31?659 individuals admitted for the first time to treatment for OUD, and who were linked with criminal justice and mortality data, were followed during a median 2.3 years. Median age at first treatment admission was 32, 35.8% were women and 37.1% primarily used prescription opioids.Daily costs of crime (US$2014) were calculated from a societal perspective and were composed of the costs of policing, court, corrections and criminal victimization. We estimated the average marginal effect of treatment engagement in OAT or detoxification adjusting for potential fixed and time-varying confounders, including drug use and criminal justice system involvement prior to treatment initiation.Daily costs of crime during treatment compared with after treatment were $126 lower for OAT [95% confidence interval (CI) = $116, $136] and $144 lower for detoxification (95% CI = $135, $154). Summing the costs of crime during and after treatment over a hypothetical 6-month period using the observed median durations of OAT (161 days) and detoxification (19 days), we estimated that enrolling an individual in OAT as opposed to detoxification would save $17?550 ($16?840, $18?383).In publicly funded drug treatment facilities in California, USA, engagement in treatment for opioid use disorders is associated with lower costs of crime in the 6 months following initiation of treatment, and the economic benefits were far greater for individuals receiving time-unlimited treatment.

Project description:Ibogaine may be effective for transitioning opioid and cocaine dependent individuals to sobriety. American and European self-help groups provided public testimonials that ibogaine alleviated drug craving and opioid withdrawal symptoms after only a single dose administration. Preclinical studies in animal models of addiction have provided proof-of-concept evidence in support of these claims. However, the purported therapeutic benefits of ibogaine are based on anecdotal reports from a small series of case reports that used retrospective recruitment procedures. We reviewed clinical results from an open label case series (N = 191) of human volunteers seeking to detoxify from opioids or cocaine with medical monitoring during inpatient treatment. Whole blood was assayed to obtain pharmacokinetic measures to determine the metabolism and clearance of ibogaine. Clinical safety data and adverse events (AEs) were studied in male and female subjects. There were no significant adverse events following administration of ibogaine in a dose range that was shown to be effective for blocking opioid withdrawal symptoms in this study. We used multi-dimensional craving questionnaires during inpatient detoxification to test if ibogaine was effective in diminishing heroin and cocaine cravings. Participants also completed standardized questionnaires about their health and mood before and after ibogaine treatment, and at program discharge. One-month follow-up data were reviewed where available to determine if ibogaine's effects on drug craving would persist outside of an inpatient setting. We report here that ibogaine therapy administered in a safe dose range diminishes opioid withdrawal symptoms and reduces drug cravings. Pharmacological treatments for opioid dependence include detoxification, narcotic antagonists and long-term opioid maintenance therapy. Our results support product development of single oral dose administration of ibogaine for the treatment of opioid withdrawal during medically supervised detoxification to transition drug dependent individuals to abstinence.

Project description:BACKGROUND: About 1963, a factory in Willits, Mendocino County (County), California added chrome plating to the manufacture of steel products. After years of residents reporting high illness rates, the State undertook a series of investigations. They found exposures had been high and warranted further research into possible health effects. Applying the seldom-used cross-sequential design, we tested if Willits had an excess rate of adverse health conditions, compared to people of the same sex and cohort living in the rest of county (ROC). This is the first report on long-term health outcomes for Willits. METHODS: Hospital discharge data for 1991-2012 were searched to find admissions for people born between 1940 and 1989 who ever gave the County as their residence. Diagnoses and procedures were classified to Level 1 (body systems) of the Multi-level Clinical Classification Software (CCS). We analyzed 796,917 diagnoses and 289,980 procedures found on 117,799 admissions of 43,234 patients who lived in the County at some time between 1991 and 2012. Of these, 7,564 lived in Willits. We summarized data to the person-level then the group level over cohort-period (cross-sequential) to control the age by time relationship, then calculated incidence rates, relative risk, and excess case statistics, each with confidence limits. A secondary analysis focused on whether Willits differed markedly from the rest of County (ROC). Specifically, other than the presence of the Plant, did Willits differ so much that those differences could plausibly explain outcome differences? RESULTS: Illness was excessive in the exposed group (Willits) compared to the unexposed (ROC). Overall number of excess cases attributable to living in Willits was estimated: Men, 301 (95% confidence limit (CL) 200-398), women: 696 (CL 569-820). CONCLUSIONS: This study demonstrates the strength of the cross-sequential design. Willits and ROC had comparable disadvantages relative to the State. Yet, when stratified by cohort, Willits had more illness per population. Little is known about the health effect of chemicals used at Willits on a non-occupationally exposed population. We recommend a follow-up study to evaluate the long-term health of people who lived in Willits during childhood and the reproductive age.

Dataset Information

Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publicly-funded facilities in California, USA: 1991-2012.

Publications

Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publicly-funded facilities in California, USA: 1991-2012.

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