CA7-04: Costs of Care for Persons With Opioid Dependence in Two Integrated Health Systems.
CA7-04: Costs of Care for Persons with Opioid Dependence in Two Integrated Health Systems.
Filed under: Methadone Treatment
Clin Med Res. 2012 Aug; 10(3): 170
Lynch F, McCarty D, Mertens J, Perrin N, Green C, Parthasarathy S, Anderson B, Koch M
Background/Aims Opioid dependence is a growing public health concern and results in high costs to individuals, health care systems, and society. Recent legislation allowing expansion of buprenorphine for replacement therapy use in general medical care settings may increase access to care for opioid dependence, but little is known about its impact on services utilization and commercial health systems costs. In this retrospective cohort study, we examined how the introduction of buprenorphine affected the pattern of medical care and addiction medicine (AM) services provided to patients with opioid dependence and associated costs. Methods Using electronic health records, we identified individuals with two or more diagnoses of opioid dependence per year from 2000 through 2008 in two large non-profit, integrated health systems (System A: N=4,425; System B: N=7122) and assessed health system utilization and costs. Results In both health systems and across the study period, the number of opioid-dependent persons increased considerably and the use of buprenorphine for opioid dependence treatment increased steadily. In System A, those receiving buprenorphine plus AM counseling had significantly higher costs than those receiving methadone plus AM counseling (Z= -9.22, p<.001), and significantly lower costs than those with little or no AM counseling (Z=2.81, p=.005). There were no differences in costs between those receiving buprenorphine plus AM counseling and those with AM counseling only (Z=1.30, p=.192). The treatment group by period interaction (?2 = 9.66, df=3, p=.022) was significant, with costs decreasing over time in the buprenorphine plus AM counseling group and increasing over time in all other groups. In System B, costs were significantly lower for the buprenorphine plus AM counseling group than for the group with little or no AM counseling (Z= -5.14, p<.001) and higher than for the group with AM counseling only (Z=5.56, p=.001). The treatment group by period interaction was not significant (?2 =1.23, df=2, p=.540). Discussion Buprenorphine treatment is emerging as a viable alternative to other AM treatment approaches for persons with opioid dependence. Results of this study provide further evidence that buprenorphine treatment can be provided at a similar cost to alternative strategies in private integrated health systems. Source
Evaluation and Management of Opioid Dependence in Pregnancy.
Filed under: Methadone Treatment
Psychosomatics. 2012 Aug 14;
Park EM, Meltzer-Brody S, Suzuki J
BACKGROUND: Opioid use disorders are a growing public health problem in the United States. Most women who are opioid-dependent are of childbearing age, and management of opioid dependence during pregnancy poses unique challenges. Assessment includes evaluation for addiction, withdrawal syndromes, and comorbid psychiatric diagnoses. Consultation-liaison (C-L) psychiatrists may also be involved in acute pain management, perinatal medication management, buprenorphine induction, and stabilization. For the past four decades, the standard of care has included methadone maintenance, but the increasing use of buprenorphine creates new treatment issues and opportunities. OBJECTIVE: To educate C-L psychiatrists in emergency and obstetrical settings about the appropriate approach toward the evaluation and basic management of women with opioid dependence in pregnancy. METHOD: The authors reviewed the consensus literature and all new treatment options on opioid dependence during pregnancy. DISCUSSION: In this review, the authors summarize known and emerging management strategies for opioid dependence in pregnancy pertinent to C-L psychiatrists.
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Risk factors for criminal recidivism — a prospective follow-up study in prisoners with substance abuse.
Filed under: Methadone Treatment
BMC Psychiatry. 2012 Aug 15; 12(1): 111
Hakansson A, Berglund M
ABSTRACT: BACKGROUND: Substance use in general has been shown to predict criminal recidivism. The present study aimed to examine potential predictors of criminal recidivism, including substance-specific substance use patterns, in prisoners with substance use. METHODS: A cohort of prisoners with substance use problems (N = 4,152) were assessed with the Addiction Severity Index (ASI) in the Swedish criminal justice system. Clients were followed for an average of 2.7 years. Criminal recidivism was defined as any return to the criminal justice system. RESULTS: During follow-up, 69 percent (n = 2,862) returned to the criminal justice system. Recidivism was associated with amphetamine and heroin use, with an additive risk for injectors, and with polysubstance use. Also, recidivism was negatively associated with alcohol, other opioids than heroin/methadone and with hallucinogenic drugs, and positively associated with previous psychiatric in-patient treatment, violent behaviour, and with a shorter index sentence. Associations remained when controlling for type of crime. CONCLUSIONS: Even when controlling for type and severity of crime, and for psychiatric problems, risk of criminal relapse was increased by substance use variables, including amphetamine, heroin and polysubstance use, and an additional risk was shown for injection drug users. These findings have implications for the need for substance abuse treatment after release from prison.
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