Expanding Treatment of Opioid Dependence Among the Privately Insured

描述(由申请人提供)：虽然有针对阿片类药物依赖的循证治疗，但只有15%的受影响个人接受了治疗。丁丙诺啡是FDA于2002年批准的一种阿片依赖治疗药物，其疗效与美沙酮相似，预计将导致治疗率的提高。尽管治疗率有所上升，但仍低得令人震惊，使大多数受影响的人面临经济困难、就业不足、丙型肝炎和艾滋病毒传播、驾驶障碍和犯罪等不良后果的风险。药物滥用的限制性保险福利可能在一定程度上解释了53%拥有私人保险的阿片依赖个人的低治疗率。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均等。这项将于2010年1月实施的法律有可能对阿片依赖的治疗模式产生重大影响。然而，其他与准入相关的因素也可能是相关的。几乎没有研究专门关注私人参保人员的治疗障碍，这些人可能与未参保或公共参保的阿片类药物依赖者相比，有不同的财务限制、时间成本和治疗态度。我们提出了两个具体的目标：(1)研究联邦药物滥用平等对私人保险资助的阿片依赖治疗使用的影响；(2)估计阿片依赖治疗属性对私人保险个人进入治疗的决定的相对重要性。首先，我们将比较从2010年开始新纳入联邦物质滥用平价法规的个人的治疗使用情况，以及已经被先前存在的州物质滥用平价法律涵盖的个人的治疗使用情况。我们将调整目前的物质滥用识别、治疗启动和治疗参与措施，以比较这两个群体在联邦平等实施之前和之后的治疗模式。其次，我们将通过得出阿片依赖个人对价格和非价格相关治疗属性的偏好来进行治疗需求分析。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一次基于网络的调查，以获取关于不同治疗属性的相对价值的信息，并估计治疗选择的改进将如何影响治疗率。国际移民组织的《改善精神健康和药物使用状况的保健服务质量报告》和NIDA 2004年的保健服务研究蓝带工作队都指出，迫切需要改善在现实世界环境中获得有效服务的情况。为了改变对阿片类药物依赖的护理，至关重要的是确定利益扩大和治疗属性对使用率的影响。 与公共卫生相关：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。虽然有针对阿片类药物依赖的循证治疗，但只有15%的受影响个人接受了治疗。为了提高治疗率，该项目旨在评估联邦平等对阿片依赖治疗使用率的影响，并估计改进治疗方案将如何影响53%有私人保险的阿片依赖个人的使用率。

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.