Due to the chronic course of opioid use disorders, it is not uncommon for people to require repeated attempts at detoxification and medication treatments before consistent, sustained remission is attained.
Due to the chronic course of opioid use disorders, it is not uncommon for people to require repeated attempts at detoxification and medication treatments before consistent, sustained remission is attained.
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California treats the largest population of individuals with opioid use disorder in the entire USA which makes it an ideal location to understand better what is associated with successful completion of detoxification and agonist medication treatment (i.e., methadone or buprenorphine) for opioid use disorder with longitudinal population level data. Prolonged retention in methadone treatment has resulted in decreased illicit drug use, HIV risk behaviors, and crime.
When out of treatment, individuals with opioid use disorder are at elevated risk for mortality that is 24 times greater than when in treatment. Elevated risk for mortality can be due to a lowered tolerance following detoxification which leaves the body vulnerable to overdose if a relapse occurs. Given the well-documented chronic course of substance use disorders, this study by Nosyk and colleagues sought to identify determinants of successful completion of detoxification and medication treatment retention in repeated attempts.
This study performed secondary data analysis on state-wide administrative data (i.e., California Outcome Measurement System) collected from publically funded drug treatment centers during the years 1991-2012. The sample consisted of all patients presenting for detoxification treatment and medication treatment (mostly methadone) which resulted in 237,709 unique individuals accounting for 885,971 treatment episodes (30.2% or 192,252 individuals were detoxification only).
Three primary outcomes were examined:
Many variables were controlled for in the analysis including age, gender, ethnicity, primary drug disorder (heroin versus prescribed opioids), primary drug use frequency, presence of secondary drug use disorder (i.e., none; other opioid; stimulant; alcohol or marijuana), education, labor force status, referral source (individual choice or otherwise), volume of treatment episodes per facility, and county level unemployment rate.
Notably, in 1994, 83.7% of the treatment episodes were detoxification compared to only 40.5% in 2010. Among individuals who never accessed medication assisted treatment, the probability of successful detoxification decreased with each successive attempt.
The odds of success were lowest among younger (under 30) and Hispanic individuals. Primary users of prescription opioids were nearly 85% more likely to have a successful detoxification than heroin users.
From the graph below: Individuals’ second detoxification attempt was 32% less likely to be successful than the first, the third was 44% less likely to be successful than the first, the fourth was 47% less likely to be successful than the first, and the fifth was 59% less likely to be successful than the first.
The duration of medication assisted treatment retention increased with each attempt.
Longer durations of medication assisted treatment were associated with:
Shorter durations of medication assisted treatment were associated with:
However, the proportion of those accessing medication treatment within 14 days of detoxification was lower among successfully detoxified individuals (51.3%) versus unsuccessfully detoxified individuals (55.3%). Furthermore, only 20.2% of the 627,687 detoxification treatment episodes were followed by admission into medication assisted treatment, and only 10.9% were admitted into medication treatment within 14 days.
This study found that 237,709 unique individuals accounted for 885,971 treatment episodes in the state of California. This highlights the recurrent course of opioid use disorder and the need to identify determinants of successful detoxification and medication assisted treatment in repeated attempts.
Thus, this treatment modality may not contribute as much to the recovery process when used in isolation from medication assisted treatment. Regarding the duration of medication treatment, each subsequent attempt increased in length. Successful detoxification had a positive effect on subsequent duration of medication treatment. Thus, detoxification may support future endeavors at medication treatment by its association with increased medication assisted treatment duration. Opioid treatment guidelines have suggested that success in opioid detoxification should be defined by subsequent linkage to medication, which is supported by this study.
The authors have suggested that future research should seek to quantify the cumulative effects of repeated detoxification, compared to methadone treatment (the standard of care) in terms of morbidity, mortality, and costs to society.
Nosyk, B., Li, L., Evans, E., Urada, D., Huang, D. (2014). Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publically-funded facilities in California, USA: 1991-2012. Drug and Alcohol Dependence, 143, 149-157.
l
California treats the largest population of individuals with opioid use disorder in the entire USA which makes it an ideal location to understand better what is associated with successful completion of detoxification and agonist medication treatment (i.e., methadone or buprenorphine) for opioid use disorder with longitudinal population level data. Prolonged retention in methadone treatment has resulted in decreased illicit drug use, HIV risk behaviors, and crime.
When out of treatment, individuals with opioid use disorder are at elevated risk for mortality that is 24 times greater than when in treatment. Elevated risk for mortality can be due to a lowered tolerance following detoxification which leaves the body vulnerable to overdose if a relapse occurs. Given the well-documented chronic course of substance use disorders, this study by Nosyk and colleagues sought to identify determinants of successful completion of detoxification and medication treatment retention in repeated attempts.
This study performed secondary data analysis on state-wide administrative data (i.e., California Outcome Measurement System) collected from publically funded drug treatment centers during the years 1991-2012. The sample consisted of all patients presenting for detoxification treatment and medication treatment (mostly methadone) which resulted in 237,709 unique individuals accounting for 885,971 treatment episodes (30.2% or 192,252 individuals were detoxification only).
Three primary outcomes were examined:
Many variables were controlled for in the analysis including age, gender, ethnicity, primary drug disorder (heroin versus prescribed opioids), primary drug use frequency, presence of secondary drug use disorder (i.e., none; other opioid; stimulant; alcohol or marijuana), education, labor force status, referral source (individual choice or otherwise), volume of treatment episodes per facility, and county level unemployment rate.
Notably, in 1994, 83.7% of the treatment episodes were detoxification compared to only 40.5% in 2010. Among individuals who never accessed medication assisted treatment, the probability of successful detoxification decreased with each successive attempt.
The odds of success were lowest among younger (under 30) and Hispanic individuals. Primary users of prescription opioids were nearly 85% more likely to have a successful detoxification than heroin users.
From the graph below: Individuals’ second detoxification attempt was 32% less likely to be successful than the first, the third was 44% less likely to be successful than the first, the fourth was 47% less likely to be successful than the first, and the fifth was 59% less likely to be successful than the first.
The duration of medication assisted treatment retention increased with each attempt.
Longer durations of medication assisted treatment were associated with:
Shorter durations of medication assisted treatment were associated with:
However, the proportion of those accessing medication treatment within 14 days of detoxification was lower among successfully detoxified individuals (51.3%) versus unsuccessfully detoxified individuals (55.3%). Furthermore, only 20.2% of the 627,687 detoxification treatment episodes were followed by admission into medication assisted treatment, and only 10.9% were admitted into medication treatment within 14 days.
This study found that 237,709 unique individuals accounted for 885,971 treatment episodes in the state of California. This highlights the recurrent course of opioid use disorder and the need to identify determinants of successful detoxification and medication assisted treatment in repeated attempts.
Thus, this treatment modality may not contribute as much to the recovery process when used in isolation from medication assisted treatment. Regarding the duration of medication treatment, each subsequent attempt increased in length. Successful detoxification had a positive effect on subsequent duration of medication treatment. Thus, detoxification may support future endeavors at medication treatment by its association with increased medication assisted treatment duration. Opioid treatment guidelines have suggested that success in opioid detoxification should be defined by subsequent linkage to medication, which is supported by this study.
The authors have suggested that future research should seek to quantify the cumulative effects of repeated detoxification, compared to methadone treatment (the standard of care) in terms of morbidity, mortality, and costs to society.
Nosyk, B., Li, L., Evans, E., Urada, D., Huang, D. (2014). Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publically-funded facilities in California, USA: 1991-2012. Drug and Alcohol Dependence, 143, 149-157.
l
California treats the largest population of individuals with opioid use disorder in the entire USA which makes it an ideal location to understand better what is associated with successful completion of detoxification and agonist medication treatment (i.e., methadone or buprenorphine) for opioid use disorder with longitudinal population level data. Prolonged retention in methadone treatment has resulted in decreased illicit drug use, HIV risk behaviors, and crime.
When out of treatment, individuals with opioid use disorder are at elevated risk for mortality that is 24 times greater than when in treatment. Elevated risk for mortality can be due to a lowered tolerance following detoxification which leaves the body vulnerable to overdose if a relapse occurs. Given the well-documented chronic course of substance use disorders, this study by Nosyk and colleagues sought to identify determinants of successful completion of detoxification and medication treatment retention in repeated attempts.
This study performed secondary data analysis on state-wide administrative data (i.e., California Outcome Measurement System) collected from publically funded drug treatment centers during the years 1991-2012. The sample consisted of all patients presenting for detoxification treatment and medication treatment (mostly methadone) which resulted in 237,709 unique individuals accounting for 885,971 treatment episodes (30.2% or 192,252 individuals were detoxification only).
Three primary outcomes were examined:
Many variables were controlled for in the analysis including age, gender, ethnicity, primary drug disorder (heroin versus prescribed opioids), primary drug use frequency, presence of secondary drug use disorder (i.e., none; other opioid; stimulant; alcohol or marijuana), education, labor force status, referral source (individual choice or otherwise), volume of treatment episodes per facility, and county level unemployment rate.
Notably, in 1994, 83.7% of the treatment episodes were detoxification compared to only 40.5% in 2010. Among individuals who never accessed medication assisted treatment, the probability of successful detoxification decreased with each successive attempt.
The odds of success were lowest among younger (under 30) and Hispanic individuals. Primary users of prescription opioids were nearly 85% more likely to have a successful detoxification than heroin users.
From the graph below: Individuals’ second detoxification attempt was 32% less likely to be successful than the first, the third was 44% less likely to be successful than the first, the fourth was 47% less likely to be successful than the first, and the fifth was 59% less likely to be successful than the first.
The duration of medication assisted treatment retention increased with each attempt.
Longer durations of medication assisted treatment were associated with:
Shorter durations of medication assisted treatment were associated with:
However, the proportion of those accessing medication treatment within 14 days of detoxification was lower among successfully detoxified individuals (51.3%) versus unsuccessfully detoxified individuals (55.3%). Furthermore, only 20.2% of the 627,687 detoxification treatment episodes were followed by admission into medication assisted treatment, and only 10.9% were admitted into medication treatment within 14 days.
This study found that 237,709 unique individuals accounted for 885,971 treatment episodes in the state of California. This highlights the recurrent course of opioid use disorder and the need to identify determinants of successful detoxification and medication assisted treatment in repeated attempts.
Thus, this treatment modality may not contribute as much to the recovery process when used in isolation from medication assisted treatment. Regarding the duration of medication treatment, each subsequent attempt increased in length. Successful detoxification had a positive effect on subsequent duration of medication treatment. Thus, detoxification may support future endeavors at medication treatment by its association with increased medication assisted treatment duration. Opioid treatment guidelines have suggested that success in opioid detoxification should be defined by subsequent linkage to medication, which is supported by this study.
The authors have suggested that future research should seek to quantify the cumulative effects of repeated detoxification, compared to methadone treatment (the standard of care) in terms of morbidity, mortality, and costs to society.
Nosyk, B., Li, L., Evans, E., Urada, D., Huang, D. (2014). Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publically-funded facilities in California, USA: 1991-2012. Drug and Alcohol Dependence, 143, 149-157.
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