Expanding Treatment of Opioid Dependence Among the Privately Insured

描述（由申请人提供）：虽然阿片类药物依赖的循证治疗是可用的，但只有15%的受影响个体接受治疗。丁丙诺啡是FDA于2002年批准的一种阿片类药物依赖治疗药物，其疗效与美沙酮相似，预计丁丙诺啡的可用性将导致治疗率的提高。虽然治疗率有所提高，但仍然低得惊人，使大多数受影响的个人面临不利后果的风险，包括经济困难，就业不足，丙型肝炎和艾滋病毒的传播，驾驶障碍和犯罪。药物滥用的限制性保险福利可能部分解释了53%拥有私人保险的阿片类药物依赖者的低治疗率。新颁布的联邦药物滥用平等法的目的是使私人对行为和身体疾病的保险平等。这项法律将于2010年1月实施，有可能对类阿片依赖的治疗模式产生重大影响。然而，其他与准入有关的因素也可能是相关的。几乎没有研究专门关注私人保险中的治疗障碍，与未保险或公共保险的阿片类药物依赖者相比，这些人可能有不同的财务限制，时间成本和对治疗的态度。我们提出两个具体目标：（1）研究联邦药物滥用均等对使用私人保险资助的阿片类药物依赖治疗的影响，（2）估计阿片类药物依赖治疗属性对私人保险个人决定进入治疗的相对重要性。首先，我们将比较2010年开始由联邦药物滥用平等法规新涵盖的个人的治疗利用率与已存在的州药物滥用平等法律所涵盖的个人的治疗利用率。我们将调整目前的药物滥用识别，治疗启动和治疗参与措施，以比较联邦均等实施前后这两组的治疗模式。其次，我们将通过引出阿片类药物依赖者对价格和非价格相关治疗属性的偏好来分析治疗需求。我们将进行定性访谈，以确定影响进入治疗决定的治疗属性。接下来，我们将对有私人保险的寻求治疗和不寻求治疗的阿片类药物依赖者进行基于网络的调查，以获取有关不同治疗属性的相对价值的信息，并估计治疗方案的改善将如何影响治疗率。国际移民组织的《提高心理健康和药物使用状况的保健质量》报告和荷兰国际开发署2004年关于保健服务研究的蓝带工作队都指出，迫切需要改善在真实的世界环境中获得有效服务的情况。为了改变阿片类药物依赖的护理，确定受益扩展和治疗属性对利用率的影响至关重要。 公共卫生相关性：阿片类药物依赖是美国的一个主要公共卫生问题，估计每年的经济成本为210亿美元。虽然阿片类药物依赖的循证治疗是可用的，但只有15%的受影响个体接受治疗。为了提高治疗率，该项目旨在评估联邦均等对阿片类药物依赖治疗使用率的影响，并估计改善治疗方案将如何影响53%的阿片类药物依赖者的使用率。

DESCRIPTION (provided by applicant): While evidence-based treatments for opioid dependence are available, only 15 percent of affected individuals receive treatment. The availability of buprenorphine, an opioid dependence treatment approved by the FDA in 2002 with similar efficacy to methadone, was expected to lead to increased treatment rates. Although treatment rates have increased somewhat, they remain alarmingly low, leaving the majority of affected individuals at risk for adverse consequences including financial hardship, under-employment, transmission of hepatitis C and HIV, impaired driving, and crime. Restrictive insurance benefits for substance abuse may partially explain low treatment rates among the 53 percent of opioid dependent individuals with private insurance. The aim of the newly-enacted federal substance abuse parity law is to equalize private coverage for behavioral and physical illnesses. This law, which will be implemented in January 2010, has the potential to substantially affect treatment patterns for opioid dependence. However, other access-related factors are also likely to be relevant. Almost no research has focused specifically on barriers to treatment among the privately insured, and these individuals may have different financial constraints, time costs, and attitudes towards treatment compared with uninsured or publicly insured opioid dependent individuals. We propose two specific aims: (1) to study the effects of federal substance abuse parity on use of opioid dependence treatment financed by private insurance and (2) to estimate the relative importance of attributes of opioid dependence treatment on privately insured individuals' decision to enter treatment. First, we will compare treatment utilization by individuals newly covered by federal substance abuse parity regulations beginning in 2010 with treatment utilization by individuals already covered under pre-existing state substance abuse parity laws. We will adapt current substance abuse identification, treatment initiation, and treatment engagement measures to compare treatment patterns for these two groups before and after federal parity implementation. Second, we will conduct an analysis of demand for treatment by eliciting opioid dependent individuals' preferences for price and non-price related treatment attributes. We will conduct qualitative interviews to identify treatment attributes that affect the decision to enter treatment. Next, we will field a web-based survey of treatment-seeking and non-treatment-seeking opioid dependent individuals with private insurance to elicit information on the relative value of different treatment attributes and to estimate how improvements in treatment options will affect treatment rates. Both the IOM Report Improving the Quality of Health Care for Mental Health and Substance- Use Conditions and NIDA's 2004 Blue Ribbon Task Force on Health Services Research identified a pressing need to improve receipt of effective services in real world settings. To transform care for opioid dependence, it is vital to identify the effects of both benefit expansion and attributes of treatment on utilization rates. PUBLIC HEALTH RELEVANCE: Opioid dependence is a major public health concern in the United States, with economic costs estimated at $21 billion per year. While evidence-based treatments for opioid dependence are available, only 15 percent of affected individuals receive treatment. With the goal of increasing treatment rates, this project aims to evaluate the effects of federal parity on rates of use for opioid dependence treatment and to estimate how improving treatment options will affect rates of use among the 53 percent of opioid dependent individuals with private insurance.