A Comparison of Methadone Treatment Systems in California and British Columbia

描述(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，并经常复发为长期使用。虽然随之而来的犯罪是主要的社会关切，但由于注射做法和其他生活方式特点，阿片成瘾者患精神健康疾病、过早死亡以及艾滋病毒和其他传染病的风险增加。美沙酮维持治疗(MMT)已被发现是治疗阿片类药物依赖的最有效形式。治疗时段的可获得性、提供MMT的方式以及可用于应对并存健康状况的辅助服务的可获得性在当地和国际上差别很大。因此，个别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，需要对其进行评估。最大限度地获得MMT的行为益处和经济价值是公认的；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(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阿片类药物依赖者的健康和经济结果不同。我们的广泛目标是在一个全面的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。加州和不列颠哥伦比亚省是美国-加拿大毒品政策的有益比较；这两个地区都是各自国家人均阿片类药物依赖者人数最多的地区，都有相对于其他州或省的进步药物治疗政策。比较获得治疗的个人类型、他们的治疗结果以及他们对刑事司法和卫生系统造成的费用，将有助于建立一个模拟模型，解释在CA和BC接受MMT的具有代表性的阿片依赖患者队列的一生中健康结果和费用的差异。模拟建模的优势在于，在保持其他因素不变的情况下，能够确定特定的政策和实践如何影响健康收益和成本。将通过一系列州/省一级关于戒毒治疗和其他卫生资源利用、逮捕和其他刑事司法系统参与情况以及生命统计数据的单独链接的行政数据库，说明各自的戒毒系统及其制定的政策。由于使用人口一级的行政数据模拟了两个截然不同的待遇和刑事司法系统，每个系统的主要特征可以一次一个地改变，或者联合改变，以确定和理清假设政策改变的预期效果。可以修改特定参数值的范围，以检查它们在比较器区中的潜在影响。CA和BC系统的投入，如治疗中的保留时间和逮捕和监禁的不同概率，可在区域内交换，以量化由于治疗系统的具体方面而导致的健康和经济结果的差异。同样，还可以模拟其他参数，包括艾滋病毒等传染病发病率的差异，从而提供关于公共卫生重要性具体方面的更多背景信息。我们预计，该模型随后可被这些司法管辖区和其他司法管辖区用作研究政策变化对阿片类药物治疗系统、干预效果及其服务对象的假设影响的工具。 公共卫生相关性：我们的最终目标是确定是否可以通过修改CA和BC的药物治疗政策和做法来获得进一步的健康和经济利益。我们假设，政府收入的节省可能源于考虑的许多假设的政策变化。这些节省的资金可以再投资于戒毒治疗、刑事司法、医疗保健或其他部门更有效、更有成效的努力。我们期望为这一观点提供经验支持，并为政府行政机构提供一个基于证据的决策工具，以帮助制定关于药物依赖的政策，以促进经济分配效率以及阿片类药物依赖者的健康和福祉。

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. PUBLIC HEALTH RELEVANCE: Our ultimate objective is to determine whether further health and economic benefits may be gained as a result of modifying drug treatment policies and practices in CA and BC. We hypothesize that savings in government revenues may result from many of the hypothetical policy changes considered. These savings could be reinvested into more effective and productive endeavors in drug treatment, criminal justice, healthcare or other sectors. We expect to deliver empirical support for this perspective and to provide an evidence based and decision-making tool for government administrative bodies to help shape policies on drug dependence that promote economic allocative efficiency and the health and well-being of opioid-dependent individuals.