Natural History, Treatment Process and Outcomes (2012-2014)


A Comparison of Methadone Treatment Systems
 in California and British Columbia

Bohdan Nosyk, Ph.D., Principal Investigator
(bnosyk@cfenet.ubc.ca)
David Huang, Libo Li, Darren Urada, Richard A. Rawson,
M. Douglas Anglin, Yih-Ing Hser, Co-Investigators
Elizabeth Evans, M.A., Project Director

Opioid dependence is a chronic, recurrent disorder with periods of stabilization during treatment and frequent relapse into chronic use.  Methadone maintenance treatment (MMT) has been found to be the most effective form of treatment for opioid dependence. 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 and British Columbia likely result in disparate health and economic outcomes for opioid-dependent individuals in these jurisdictions.  Our broad objective is to quantify these differences to determine the effects of actual and simulated policies and practices and how they are manifested in the long-term in these contrasting regions. 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.  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 and the clients they serve.

Publications that have resulted from this project include:

Evans, E., Li, L., Min, J., Huang, D., Urada, D., Liu, L., Hser, Y.I., & Nosyk, B. (2015). Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006-2010. Addiction. 2015 Feb 1. doi: 10.1111/add.12863. [Epub ahead of print] PubMed PMID: 25644938.

Krebs, E., Kerr, T., Montaner, J., Wood, E., & Nosyk, B. (2014). Dynamics in the costs of criminality among opioid dependent individuals. Drug and Alcohol Dependence, 144, 193-200. doi: 10.1016/j.drugalcdep.2014.09.007. Epub 2014 Sep 22. PubMed PMID: 25282307.

Nosyk, B., Li, L., Evans, E., Urada, D., Huang, D., Wood, E., Rawson, R., & Hser, Y.I. (2014). Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publicly-funded facilities in California, USA: 1991-2012. Drug and Alcohol Dependence,143,149-157. doi: 10.1016/j.drugalcdep.2014.07.020. Epub 2014 Jul 27. PubMed PMID: 25110333.

Nosyk, B., Anglin, M.D., Brissette, S., Kerr, T., Marsh, D.C., Schackman, B.R., Wood, E., & Montaner, J.S. (2013). A call for evidence-based medical treatment of opioid dependence in  the United States and Canada. Health Aff (Millwood), 32(8), 1462-1469. doi:  10.1377/hlthaff.2012.0846. PubMed PMID: 23918492.

Sharif, B., Nosyk, B., Sun, H., Marsh, D.C., & Anis, A. (2013). Changes in the characteristics and levels of comorbidity among new patients into methadone maintenance treatment program in British Columbia during its expansion period from 1998-2006. Substance Use and Misuse,48(8), 671-682. doi: 10.3109/10826084.2013.800119.  PubMed PMID: 23750776.

A Comparison of Methadone Treatment Systems in California and British Columbia was funded by the National Institute on Drug Abuse, grant 1 R01 DA031727, from July 2011 to May 2015.


An Empirical Investigation into
Recovery from Illicit Drug Abuse
Using Recurrent Event Analysis

Bohdan Nosyk, Ph.D., Principal Investigator,
with a subcontract to Yih-Ing Hser, Ph.D., yhser@ucla.edu
Julio Montaner, Ph.D., Co-Investigator
Elizabeth Evans, M.A., Project Director

Recurrent event analysis is an emerging innovative methodology that is well suited to identifying the determinants of each of the stages of recovery from drug abuse, including regular use, treatment, relapse, and abstinence, as well as its attendant behaviors. Our specific aims include analyses on the determinants of durations of: (a) alternating periods of drug treatment and relapse among opioid users; (b) successive periods of drug-use frequency in single-drug users (c) parallel durations of drug use among multiple-drug users; and (d) joint analysis of the cumulative and acute effects of recurrent durations of drug treatment on morbidity and mortality. In each case, we examine the modifying effect of HIV infection on the course of recovery from drug abuse. We expect to generate new insights into the course and determinants of recovery from illicit drug dependence that can be used in policy development and in clinical practice to identify promising leverage points for re-engineering interventions in ways that shorten the relapse-treatment-recovery cycle, to increase the long-term effectiveness of treatment and decrease the incidence of HIV/AIDS.

An Empirical Investigation into Recovery from Illicit Drug Abuse Using Recurrent Event Analysis was funded by the National Institute on Drug Abuse, grant R01 DA032551, from July 2012 through June 2015.


Methamphetamine Abuse:
Long-Term Trajectories, Correlates, Treatment Effects

Mary-Lynn Brecht, Ph.D., Principal Investigator
(lbrecht@ucla.edu)
Diane Herbeck, MA, Project Director

This project is an 8-year follow-up of 596 previously studied methamphetamine (meth) users, half recruited from drug treatment participation in Los Angeles County and half with no prior meth treatment at recruitment. A total of 460 of the 549 surviving non-incarcerated participants who had agreed to be re-interviewed completed the 8-year follow-up study. The project uses the Natural History Interview to collect detailed histories of substance use, treatment, and criminal careers; these new data combined with previously collected data will produce life-course trajectories averaging at least 28 years in duration, covering teen and adult periods. Additional data will come from administrative records from several state agencies. The sample is 35% female and 33% Hispanic, 38% non-Hispanic White, 17% African American, and 12% “other” ethnicity.  Participants were 28-74 years of age (average 42) at the beginning of the follow-up study. Analyses describe the current status and extended patterns of meth and other substance use, including escalation, deceleration, and possible cessation and recovery; examine drug treatment utilization patterns and their relationship to meth-use patterns; describe health morbidity and mortality; assess long-term outcomes (14 or more years) of a previously identified drug treatment episode (for the subsample recruited from treatment); and estimate cumulative social costs of meth abuse for the sample in terms of criminal activity, incarceration, and drug treatment, and health and mental health services utilization. Analysis methods will include growth models and growth mixture models. Selected findings as of March 2015 include the following. (1) Among the treated sample, 61% relapsed to meth use within 1 year after discharge from the index treatment in 1995-6 and 25% relapsed during years 2-5. Significant protective factors predicting longer time to relapse included having experienced serious meth-related psychiatric/behavioral problems, longer treatment duration, and participating in self-help or other treatment during the posttreatment abstinence period; risk factors for shorter time to relapse included having a parent with alcohol and/or drug use problems and involvement in meth sales.  (2) In-depth qualitative interviews indicate that individualized interventions and multiple, simultaneous approaches and resources were essential in reaching stable abstinence (Herbeck, Brecht et al., 2014). (3) Results from the Automated Neuropsychological Assessment Metrics (ANAM) battery of tests examining cognitive accuracy, processing speed, and efficiency show that individuals who used meth in the month preceding the ANAM test exhibited lower accuracy but faster speed on tests of learning, spatial memory, and delayed memory; meth users presenting with high levels of past-month meth use, poly-substance use (particularly crack/cocaine), violent behavior problems, and/or significant depressive symptomatology may be at particular risk for cognitive deficits.

Further description of the study can be found in Bolanos et al. (2012) and selected findings can be found in the references below.

Bolanos, F., Herbeck, D., Christou, D., Lovinger, K., Pham, A., Raihan, A., Rodriguez, L., Sheaff, P., & Brecht, M-L. (2012). Using Facebook to maximize follow-up response rates in a longitudinal study of adults who use methamphetamine. Substance Abuse: Research and Treatment, 6, 1-11.

Brecht M-L, Herbeck DM. (2014a). Time to relapse following treatment for methamphetamine use: a long-term perspective on patterns and predictors. Drug & Alcohol Dependence, 139, 18-25.

Brecht M-L, Herbeck DM. (2014b). Pregnancy and Fetal Loss Reported by Methamphetamine-Using Women. Substance Abuse: Research and Treatment, 8, 25-33.

Brecht M-L, Herbeck DM. (2013). Methamphetamine Use and Violent Behavior: User Perceptions and Predictors. Journal of Drug Issues, 43, 468-482.

Brecht M-L, Lovinger K, Herbeck DM, Urada D. (2013). Patterns of Treatment Utilization and Methamphetamine Use during First Ten Years after Methamphetamine Initiation. Journal of Substance Abuse Treatment, 44, 548–556.

Herbeck, D., Brecht, M-L, & Lovinger, K. (in press). Mortality, causes of death and health status among methamphetamine users. Journal of Addictive Diseases

Herbeck, D., Brecht, M.-L., Christou, D., & Lovinger, K. (2014) A qualitative study of methamphetamine users’ perspectives on barriers and facilitators of drug abstinence. Journal of Psychoactive Drugs. 46, 215-225. PMID:24685563

Herbeck DM, Brecht M-L. (2013). Substance use and mental health characteristics associated with cognitive functioning among adults who use methamphetamine. Journal of Addictive Diseases, 32, 11-25.

Herbeck DM, Brecht M-L, Lovinger K, Raihan A, Christou D, and Sheaff P. (2013). Poly-drug and marijuana use among adults who primarily used methamphetamine. Journal of Psychoactive Drugs, 45, 132-140.

Herbeck DM, Brecht M-L, & Pham AZ. (2013). Racial/ethnic differences in health status and morbidity among adults who use methamphetamine. Psychology, Health, & Medicine, 18, 262-274.

Methamphetamine Abuse: Long-Term Trajectories, Correlates, Treatment Effects was funded by the National Institute on Drug Abuse, grant 1 R01 DA025113-01A1, from July 2009 to May 2015.

 

Last Updated:  11/25/2015

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