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: 8286871
• 负责人: Bohdan Nosyk
• 金额: $ 17.09万
• 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 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8286871
• 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）：阿片类药物依赖是一种慢性、复发性疾病，在治疗期间有稳定期，经常复发为慢性使用。虽然随之而来的犯罪是社会关注的主要问题，但由于注射做法和其他生活方式特点，类阿片成瘾者患精神健康状况、过早死亡以及艾滋病毒和其他传染病的风险较高。美沙酮维持治疗（MMT）已被发现是治疗阿片类药物依赖最有效的形式。治疗时段的可得性、提供MMT的方式以及治疗合并症的辅助服务的可得性在地方和国际上差别很大。因此，个人药物治疗做法的可及性、全面性和质量具有重要的公共卫生影响，需要进行评估。最大限度地获得MMT的行为效益和经济效益是公认的；增加获得高质量MMT的机会也可能有助于遏制艾滋病毒在注射吸毒者中的传播。加利福尼亚州和不列颠哥伦比亚省在药物治疗和刑事司法政策方面的差异可能导致这些司法管辖区阿片类药物依赖者的健康和经济结果不同。我们的主要目标是在一个综合模型中量化这些差异，以确定实际和模拟的政策和做法的影响，以及它们在这些不同地区的长期表现。CA和BC为美加毒品政策提供了翔实的比较；这两个区域的人均阿片类药物依赖者人口都是其国家中最多的，并且都具有相对于其他州或省的渐进药物治疗政策。比较获得治疗的个人类型，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费用，将有助于拟合一个模拟模型，解释在加利福尼亚州和不列颠哥伦比亚省接受MMT的阿片类药物依赖患者的代表性队列的健康结果和费用在整个生命周期中的差异。仿真建模的优点是能够在保持其他因素不变的情况下确定特定政策和实践如何影响健康效益和成本。将通过一系列州/省一级与个人有关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参与以及生命统计数据的行政数据库来描述各自的药物治疗系统和形成这些系统的政策。利用人口水平的行政数据对两种截然不同的待遇和刑事司法系统进行建模，每个系统的关键特征可以一次或联合改变，以确定和分析假设政策变化的预期影响。可以修改特定参数值的范围，以检查它们在比较器区域中的潜在影响。可以在区域内交换来自CA和BC系统的输入，例如治疗的保留时间以及逮捕和监禁的不同概率，以量化治疗系统具体方面造成的健康和经济结果的差异。同样，包括艾滋病毒等传染病发病率差异在内的其他参数也可以建立模型，从而就具有公共卫生意义的具体方面提供更多的背景信息。我们期望该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、干预效果及其所服务的客户的假设影响。