Bohdan Nosyk1, Libo Li2, Elizabeth Evans2, Darren Urada2, David Huang2, Evan Wood3, Richard Rawson2, Yih-Ing Hser2. 1. BC Centre for Excellence in HIV/AIDS, 613-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Faculty of Health Sciences, Simon Fraser University, Canada; UCLA Integrated Substance Abuse Programs, USA. Electronic address: bnosyk@cfenet.ubc.ca. 2. UCLA Integrated Substance Abuse Programs, USA. 3. BC Centre for Excellence in HIV/AIDS, 613-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Andrew Rosenblum; Herman Joseph; Chunki Fong; Steven Kipnis; Charles Cleland; Russell K Portenoy Journal: JAMA Date: 2003-05-14 Impact factor: 56.272
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Authors: B Nosyk; J W Bray; E Wittenberg; B Aden; A A Eggman; R D Weiss; J Potter; A Ang; Y-I Hser; W Ling; B R Schackman Journal: Drug Alcohol Depend Date: 2015-10-25 Impact factor: 4.492
Authors: Emanuel Krebs; Jeong E Min; Elizabeth Evans; Libo Li; Lei Liu; David Huang; Darren Urada; Thomas Kerr; Yih-Ing Hser; Bohdan Nosyk Journal: Med Decis Making Date: 2016-12-27 Impact factor: 2.583