A Comparison of Methadone Treatment Systems in California and British Columbia

加利福尼亚州和不列颠哥伦比亚省美沙酮治疗系统的比较

• 批准号: 8452165
• 负责人: Bohdan Nosyk
• 金额: $ 16.4万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8452165
• 关键词: Abstinence; Acute; Address; Administrative Districts; Aftercare; Age; Ambulatory Care; Behavioral; British Columbia; California; Cessation of life; Characteristics; Chronic; Client; Communicable Diseases; Comorbidity; Computer Simulation; Costs and Benefits; Country; Crime; Criminal Justice; Data; Data Set; Data Sources; Databases; Decision Making; Disease; Drug Addiction; Drug Metabolic Detoxication; Economics; Emergency Situation; Evaluation; Female; Funding; Goals; Government; HIV; HIV Seropositivity; Health; Health Benefit; Health Care Costs; Health Resources; Health system; Healthcare; Imprisonment; Incidence; Individual; Injecting drug user; Injection of therapeutic agent; Inpatients; Life Style; Link; Medical; Mental Health; Methadone; Modeling; NIH Program Announcements; Opiate Addiction; Opioid; Outcome; Outpatients; Patients; Pattern; Performance; Personal Satisfaction; Pharmaceutical Preparations; Pharmacological Treatment; Philosophy; Policies; Population; Premature Mortality; Probability; Province; Public Health; Publishing; Quality-Adjusted Life Years; Recording of previous events; Recurrence; Relapse; Relative (related person); Relative Risks; Research; Research Personnel; Risk; Savings; Series; Services; Severities; Shapes; Simulate; Social Work; Socioeconomic Status; Subgroup; Supervision; System; Time; TimeLine; Treatment outcome; Vital Statistics; administrative database; base; cohort; cost; demographics; economic outcome; evidence base; health care service utilization; health economics; interest; intervention effect; methadone maintenance; models and simulation; mortality; opioid abuse; parole; probation; simulation; social; tool

DESCRIPTION (provided by applicant): Opioid dependence is a chronic, recurrent disorder with periods of stabilization during treatment and frequent relapse into chronic use. While attendant crime is of primary social concern, because of injection practices and other lifestyle characteristics, opioid addicts are at elevated risk of mental health conditions, premature mortality, and HIV and other communicable diseases. Methadone Maintenance Treatment (MMT) has been found to be the most effective form of treatment for opioid dependence. The availability of treatment slots, the means by which MMT is delivered, and availability of ancillary services to address co-morbid health conditions varies greatly locally and internationally. Accordingly, the accessibility, comprehensiveness and quality of individual drug treatment practices have important public health implications that require evaluation. The behavioral benefits and economic merits of maximizing access to MMT are well-established; increased access to quality MMT may also help contain the spread of HIV among injection drug users. Differences in drug treatment and criminal justice policies in California (CA) and British Columbia (BC) likely result in different health and economic outcomes for opioid dependent individuals in these jurisdictions. Our broad objective is to quantify these differences within a comprehensive model to determine the effects of actual and simulated policies and practices and how they are manifested in the long-term in these contrasting regions. CA and BC make for an informative comparison in US-Canadian drug policy; both regions feature among the largest per capita populations of opioid dependent individuals in their countries and both feature progressive drug treatment policies relative to other states or provinces. Comparing the types of individuals accessing treatment, their treatment outcomes and the costs they incur on the criminal justice and health systems will contribute to fitting a simulation model explicating the differences in health outcomes and costs over the lifetime of a representative cohort of opioid dependent patients presenting for MMT in CA versus BC. Simulation modeling provides the advantage of being able to determine how specific policies and practices impact health benefits and costs holding other factors constant. The respective drug treatment systems and the policies shaping them will be described through a series of state/province- level individually-linked administrative databases on drug treatment and other health resource utilization, arrests and other criminal justice system involvement, and vital statistics. With two disparate treatment and criminal justice systems being modeled using population-level administrative data, key features of each system can be altered one-at- a-time or jointly to determine and disentangle the expected effect of hypothetical policy changes. A range of specific parameter values can be modified to examine their potential effects in the comparator regions. Inputs from the CA and BC systems such as duration of retention in treatment and differential probability of arrest and incarceration may be exchanged in the regions to quantify differences in health and economic outcomes as a result of specific aspects of the treatment systems. Similarly, other parameters including differences in the incidence of infectious diseases such as HIV can also be modeled, thus providing greater contextual information on specific aspects of public health significance. We expect that the model can subsequently be used as a tool by these and other jurisdictions to study hypothetical effects of policy changes on opioid treatment systems, intervention effects, and the clients they serve.

描述（由申请人提供）：阿片类药物依赖性是一种慢性复发性疾病，在治疗过程中稳定时期，并经常复发到慢性使用中。尽管随之而来的犯罪是社会上的主要关注点，但由于注射习惯和其他生活方式特征，阿片类药物瘾者的心理健康状况，过早死亡，艾滋病毒和其他传染病的风险较高。美沙酮维持治疗（MMT）已被发现是阿片类药物依赖性的最有效治疗形式。治疗插槽的可用性，提供MMT的手段以及解决合并症健康状况的辅助服务的可用性在当地和国际上有很大的变化。因此，单个药物治疗实践的可及性，全面性和质量具有需要评估的重要公共卫生影响。最大化获得MMT的行为益处和经济优势是良好的；增加获得优质MMT的机会也可能有助于遏制注射吸毒者中HIV的传播。 加利福尼亚州（CA）和不列颠哥伦比亚省（BC）的药物治疗和刑事司法政策的差异可能会导致这些司法管辖区中阿片类药物依赖人的健康和经济成果不同。我们的广泛目标是在综合模型中量化这些差异，以确定实际和模拟策略和实践的影响，以及它们在这些对比区域中如何在长期中表现出来。 CA和BC对美国加拿大毒品政策进行了丰富的比较；这两个区域均属于其国家中阿片类药物依赖人群的人均人群中，并且均相对于其他州或省份采用了渐进式药物治疗政策。比较接受治疗的个人的类型，他们的治疗结果以及他们在刑事司法和卫生系统上产生的成本将有助于拟合模拟模型，以阐明代表性的阿片类药物依赖性患者在CA与BC与BC相比，依赖阿片类药物依赖性患者的寿命差异和成本的差异。 仿真建模提供了能够确定特定政策和实践如何影响健康福利和成本持续不变的优势。各自的药物治疗系统和塑造它们的政策将通过一系列州/省级的单独连接的药物治疗和其他卫生资源利用，逮捕和其他刑事司法系统的参与以及重要统计数据来描述。通过使用人口级行政数据对两个不同的治疗和刑事司法系统进行建模，可以单时或共同改变每个系统的关键特征，以确定和解开假设政策变化的预期影响。可以修改一系列特定参数值，以检查其在比较区域中的潜在影响。 CA和BC系统的投入，例如在治疗中保留的持续时间以及逮捕和监禁的差异概率，可以在该地区进行量化，以量化治疗系统的特定方面的健康和经济成果差异。同样，其他参数（包括艾滋病毒等传染病发生率的差异）也可以进行建模，从而提供有关公共卫生意义的特定方面的更大上下文信息。我们预计，这些模型随后可以被这些和其他司法管辖区用作工具，以研究政策变化对阿片类药物治疗系统，干预效果及其服务客户的假设影响。