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Estimating State Transitions for Opioid Use Disorders.

Emanuel Krebs1, Jeong E Min1, Elizabeth Evans2

  • 1British Columbia Centre for Excellence in HIV/AIDS (EK, JEM, TK, BN).

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|December 28, 2016
PubMed
Summary
This summary is machine-generated.

Prescription opioid (PO) users with opioid use disorder (OUD) transition to treatment differently than heroin users. While PO users may stay in treatment longer, they also spend more time out of treatment, highlighting gaps in continuous care for OUD.

Keywords:
criminal justiceheroinopioid use disorder treatmentprescription opioidsstate transitionssubdistribution hazard model

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Area of Science:

  • Addiction Medicine
  • Public Health
  • Health Economics

Background:

  • Opioid use disorder (OUD) presents significant public health challenges, necessitating research into treatment transitions.
  • Understanding patient flow between treatment, legal supervision, and incarceration is crucial for effective OUD management.

Purpose of the Study:

  • To estimate transition rates between treatment, legal supervision, incarceration, and out-of-treatment states for prescription opioid (PO) and heroin users.
  • To compare the transition dynamics between individuals primarily using POs versus heroin.

Main Methods:

  • Utilized linked data from publicly funded OUD treatment admissions in California (2006-2010) including mortality and criminal justice records.
  • Employed Cox proportional hazards and competing risks models to analyze transitions among five states: detoxification, opioid agonist treatment (OAT), legal supervision, incarceration, and out-of-treatment.
  • Modeled death as an absorbing state, with transitions conditional on survival.

Main Results:

  • Both PO and heroin users spent the majority of their observation time out of treatment.
  • PO users were younger, more often female, white, and had higher high school completion rates compared to heroin users.
  • PO users showed a higher hazard of transitioning from detoxification to OAT but a lower hazard of transitioning from out-of-treatment to detoxification or OAT compared to heroin users.

Conclusions:

  • Findings are applicable to state transition modeling for health economic evaluations in OUD.
  • PO users may have longer treatment durations but also longer periods out of treatment, indicating potential for extended periods of unmet need.
  • Despite effective treatments, individuals with OUD frequently experience extended periods out of care.