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Graves BD, Fendrich M. Community-based substance use treatment programs for reentering justice-involved adults: A scoping review. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 10:100221. [PMID: 38425420 PMCID: PMC10901914 DOI: 10.1016/j.dadr.2024.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
Introduction For adults involved with the criminal justice system who are reentering their communities post-incarceration, there is a large need for community-based substance use treatment. Little is known, however, about the types, availability, and benefits of programs targeting the reentry population in community settings that operate independently from the criminal justice system. Methods We conducted a scoping review of community-based treatment programs for substance use among reentering justice-involved adults to examine the contemporary state of literature and identify research gaps. We searched four databases for peer-reviewed articles conducted in the United States and published between 2017 and 2021. Results The final sample included 58 articles. Interventions varied, but the two most prominent were medications for opioid use disorder (35%) and peer support or social support interventions (22.4%). Studies were more likely to show positive impact on substance use outcomes than criminal justice outcomes. Themes were identified around participant characteristics, treatment delivery, and treatment benefits. Conclusions Findings from this scoping review suggest that the range of evidence-based strategies for substance use treatment targeting the reentry population is growing, but there is a need for additional research that examines implementation, cost effectiveness, and racial/ethnic disparities.
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Cepeda JA, Beletsky L, Abramovitz D, Saldana CR, Kahn JG, Bañuelos A, Rangel G, Arredondo J, Vickerman P, Bórquez A, Strathdee SA, Martin NK. Cost-effectiveness of a police education program on HIV and overdose among people who inject drugs in Tijuana, Mexico. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100679. [PMID: 38327278 PMCID: PMC10847144 DOI: 10.1016/j.lana.2024.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
Background Incarceration is associated with drug-related harms among people who inject drugs (PWID). We trained >1800 police officers in Tijuana, Mexico on occupational safety and HIV/HCV, harm reduction, and decriminalization reforms (Proyecto Escudo). We evaluated its effect on incarceration, population impact and cost-effectiveness on HIV and fatal overdose among PWID. Methods We assessed self-reported recent incarceration in a longitudinal cohort of PWID before and after Escudo. Segmented regression was used to compare linear trends in log risk of incarceration among PWID pre-Escudo (2012-2015) and post-Escudo (2016-2018). We estimated population impact using a dynamic model of HIV transmission and fatal overdose among PWID, with incarceration associated with syringe sharing and fatal overdose. The model was calibrated to HIV and incarceration patterns in Tijuana. We compared a scenario with Escudo (observed incarceration declines for 2 years post-Escudo among PWID from the segmented regression) compared to a counterfactual of no Escudo (continuation of stable pre-Escudo trends), assessing cost-effectiveness from a societal perspective. Using a 2-year intervention effect and 50-year time horizon, we determined the incremental cost-effectiveness ratio (ICER, in 2022 USD per disability-adjusted life years [DALYs] averted). Findings Compared to stable incarceration pre-Escudo, for every three-month interval in the post-Escudo period, recent incarceration among PWID declined by 21% (adjusted relative risk = 0.79, 95% CI: 0.68-0.91). Based on these declines, we estimated 1.7% [95% interval: 0.7%-3.5%] of new HIV cases and 12.2% [4.5%-26.6%] of fatal overdoses among PWID were averted in the 2 years post-Escudo, compared to a counterfactual without Escudo. Escudo was cost-effective (ICER USD 3746/DALY averted compared to a willingness-to-pay threshold of $4842-$13,557). Interpretation Escudo is a cost-effective structural intervention that aligned policing practices and human-rights-based public health practices, which could serve as a model for other settings where policing constitutes structural HIV and overdose risk among PWID. Funding National Institute on Drug Abuse, UC MEXUS CONACyT, and the San Diego Center for AIDS Research (SD CFAR).
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Affiliation(s)
- Javier A. Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Leo Beletsky
- School of Law, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | - Carlos Rivera Saldana
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | - James G. Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | | | - Gudelia Rangel
- Mexico Section, U.S.-Mexico Border Health Commission, Tijuana, Mexico
| | - Jaime Arredondo
- Canadian Institute for Substance Use Research, University of Victoria, BC, Canada
| | - Peter Vickerman
- Population Health Science Institute, University of Bristol, UK
| | - Annick Bórquez
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
- Population Health Science Institute, University of Bristol, UK
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Lebenbaum M, Kouyoumdjian F, Huang A, Kurdyak P. The Association Between Prior Mental Health Service Utilization and Risk of Recidivism among Incarcerated Ontario Residents. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:21-32. [PMID: 36518095 PMCID: PMC10867412 DOI: 10.1177/07067437221140385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is mixed evidence on the link between mental health and addiction (MHA) history and recidivism. Few studies have examined post-release MHA care. Our objective was to examine the association between prior (pre-incarceration) MHA service use and post-release recidivism and service use. METHODS We conducted a population-based cohort study linking individuals held in provincial correctional institutions in 2010 to health administrative databases. Prior MHA service use was assigned hierarchically in order of hospitalization, emergency department visit and outpatient visit. We followed up individuals post-release for up to 5 years for the first occurrence of recidivism and MHA hospitalization, emergency department visit and outpatient visit. We use Cox-proportional hazards models to examine the association between prior MHA service use and each outcome adjusting for prior correctional involvement and demographic characteristics. RESULTS Among a sample consisting of 45,890 individuals, we found that prior MHA service use was moderately associated with recidivism (hazard ratio (HR): 1.20-1.50, all P < 0.001), with secondary analyses finding larger associations for addiction service use (HR range: 1.34-1.54, all P < 0.001) than for mental health service use (HR range: 1.09-1.18, all P < 0.001). We found high levels of post-release MHA hospitalization and low levels of outpatient MHA care relative to need even among individuals with prior MHA hospitalization. DISCUSSION Despite a high risk of recidivism and acute MHA utilization post-release, we found low access to MHA outpatient care, highlighting the necessity for greater efforts to facilitate access to care and care integration for individuals with mental health needs in correctional facilities.
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Affiliation(s)
- Michael Lebenbaum
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Fiona Kouyoumdjian
- ICES, Toronto, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Paul Kurdyak
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Brandeau ML. Responding to the US opioid crisis: leveraging analytics to support decision making. Health Care Manag Sci 2023; 26:599-603. [PMID: 37804456 DOI: 10.1007/s10729-023-09657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
The US is experiencing a severe opioid epidemic with more than 80,000 opioid overdose deaths occurring in 2022. Beyond the tragic loss of life, opioid use disorder (OUD) has emerged as a major contributor to morbidity, lost productivity, mounting criminal justice system costs, and significant social disruption. This Current Opinion article highlights opportunities for analytics in supporting policy making for effective response to this crisis. We describe modeling opportunities in the following areas: understanding the opioid epidemic (e.g., the prevalence and incidence of OUD in different geographic regions, demographics of individuals with OUD, rates of overdose and overdose death, patterns of drug use and associated disease outbreaks, and access to and use of treatment for OUD); assessing policies for preventing and treating OUD, including mitigation of social conditions that increase the risk of OUD; and evaluating potential regulatory and criminal justice system reforms.
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Affiliation(s)
- Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
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Martin NK, Beletsky L, Linas BP, Bayoumi A, Pollack H, Larney S. Modeling as Visioning: Exploring the Impact of Criminal Justice Reform on Health of Populations with Substance Use Disorders. MDM Policy Pract 2023; 8:23814683231202984. [PMID: 37841498 PMCID: PMC10568988 DOI: 10.1177/23814683231202984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 08/20/2023] [Indexed: 10/17/2023] Open
Abstract
In the context of historic reckoning with the role of the criminal-legal system as a structural driver of health harms, there is mounting evidence that punitive drug policies have failed to prevent problematic drug use while fueling societal harms. In this explainer article, we discuss how simulation modeling provides a methodological framework to explore the potential outcomes (beneficial and harmful) of various drug policy alternatives, from incremental to radical. We discuss potential simulation modeling opportunities while calling for a more active role of simulation modeling in visioning and operationalizing transformative change. Highlights This article discusses opportunities for simulation modeling in projecting health and economic impacts (beneficial and harmful) of drug-related criminal justice reforms.We call on modelers to explore radical interventions to reduce drug-related harm and model grand alternative futures in addition to more probable scenarios, with a goal of opening up policy discourse to these options.
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Affiliation(s)
- Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
- School of Law, Bouvé College of Health Sciences, and Health in Justice Action Lab, Northeastern University, USA
| | | | - Ahmed Bayoumi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Harold Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, USA
| | - Sarah Larney
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
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Tran AD, Weatherburn D, Poynton S. The savings associated with decriminalization of drug use in New South Wales, Australia: A comparison of four drug policies. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 149:208983. [PMID: 36934043 DOI: 10.1016/j.josat.2023.208983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 12/06/2022] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Most Australian states and territories have established some form of scheme to divert minor drug offenders from court. However, the number charged with drug possession continues to rise. We examine the costs of four alternatives to existing policy in relation to people apprehended by police using or in possession of a prohibited drug. METHODS We construct a Markov micro-simulation model to examine four policies: (1) current policy; (2) expanding the existing cannabis cautioning scheme to all drug use/possession offences; (3) issuing an infringement notice to all those found using or in possession of a prohibited drug; (4) prosecuting all drug use/possession offences in the courts. The cycle length is one month. Since our aim is to examine the cost to the government, all costs are taken from the Government perspective and are in 2020 Australian dollars. RESULTS The current estimated annual cost per offence is $977 (SD: $293). Policy 2 costs $507 per offence per year (SD: $106). Policy 3 turns into a net revenue gain of $225 (SD: $68) per offence per annum. Policy 4 lifts the current cost of processing from $977 to $1282 per offence per year (SD: $321). CONCLUSIONS Extending the cannabis cautioning scheme to all drugs would reduce the cost of current policy by more than 50 %. A policy of issuing infringement notices or cautions for drug use/possession would save costs and generate income for the government.
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Affiliation(s)
- Anh Dam Tran
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.
| | - Don Weatherburn
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Miller GF, Barnett SB, Wulz AR, Luo F, Florence C. Costs attributable to criminal justice involvement in injuries: a systematic review. Inj Prev 2023; 29:91-100. [PMID: 36600522 PMCID: PMC10101176 DOI: 10.1136/ip-2022-044756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT Costs related to criminal justice are an important component of the economic burden of injuries; such costs could include police involvement, judicial and corrections costs, among others. If the literature has sufficient information on the criminal justice costs related to injury, it could be added to existing estimates of the economic burden of injury. OBJECTIVE To examine research on injury-related criminal justice costs, and what extent cost information is available by type of injury. DATA SOURCES Medline, PsycINFO, Sociological Abstracts ProQuest, EconLit and National Criminal Justice Reference Service were searched from 1998 to 2021. DATA EXTRACTION Preferred Reporting Items for Systematic reviews and Meta-Analyses was followed for data reporting. RESULTS Overall, 29 studies reported criminal justice costs and the costs of crime vary considerably. CONCLUSIONS This study illustrates possible touchpoints for cost inputs and outputs in the criminal justice pathway, providing a useful conceptualisation for better estimating criminal justice costs of injury in the future. However, better understanding of all criminal justice costs for injury-related crimes may provide justification for prevention efforts and potentially for groups who are disproportionately affected. Future research may focus on criminal justice cost estimates from injuries by demographics to better understand the impact these costs have on particular populations.
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Affiliation(s)
- Gabrielle F Miller
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Beth Barnett
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Avital Rachelle Wulz
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Feijun Luo
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Curtis Florence
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Risk factors for relapse among methamphetamine users receiving a joint legal-medical treatment program as a diversion intervention: A one-year follow-up study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023:208955. [PMID: 36804075 DOI: 10.1016/j.josat.2023.208955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/26/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Methamphetamine (METH) is a Schedule II illicit drug in Taiwan. A 12-month legal-medical joint intervention program has been developed for first-time METH offenders during deferred prosecution. Risk factors associated with METH relapse use among these individuals were unknown. METHODS We enrolled a total of 449 METH offenders referred by the Taipei District Prosecutor's Office to Taipei City Psychiatric Center. The study defines relapse as having any positive urine toxicology result or self-report of METH use during 12-month treatment. We compared demographic and clinical variables between a relapse group and nonrelapse group and used a Cox proportional hazards model to determine variables associated with time to relapse. RESULTS Of all participants, 37.8 % relapsed to use METH and 23.2 % were noncompleters in the one-year follow-up. Compared to the nonrelapse group, the relapse group had lower educational attainment, more severe psychological symptoms, longer duration of METH use, higher odds of polysubstance use, higher craving severity, and higher odds of positive baseline urine. The Cox analysis revealed individuals with positive urine results and higher craving severity at baseline were at higher risks of METH relapse (hazard ratio [95 % CI]: 3.85 [2.61-5.68] and 1.71 [1.19-2.46], respectively, p < 0.001). Baseline positive urine results and high craving could also predict a shorter length of time to relapse than their respective counterparts. CONCLUSIONS Positive urine screening for METH at baseline and high craving severity are two indicators of an increased risk of drug relapse. Tailored treatment plans incorporating these findings to prevent relapse are warranted in our joint intervention program.
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Humphreys K, Shover CL, Andrews CM, Bohnert ASB, Brandeau ML, Caulkins JP, Chen JH, Cuéllar MF, Hurd YL, Juurlink DN, Koh HK, Krebs EE, Lembke A, Mackey SC, Larrimore Ouellette L, Suffoletto B, Timko C. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet 2022; 399:555-604. [PMID: 35122753 PMCID: PMC9261968 DOI: 10.1016/s0140-6736(21)02252-2] [Citation(s) in RCA: 182] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/01/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Christina M Andrews
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Amy S B Bohnert
- Department of Psychiatry and Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Huang Engineering Center, Stanford University, Stanford, CA USA
| | | | - Jonathan H Chen
- Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA; Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yasmin L Hurd
- Addiction Institute, Icahn School of Medicine, New York, NY, USA
| | - David N Juurlink
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Erin E Krebs
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Center for Care Delivery and Outcomes Research, Veterans Affairs Minneapolis Health Care System, Minneapolis, MN, USA
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine Timko
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Ward Z, Stone J, Bishop C, Ivakin V, Eritsyan K, Deryabina A, Low A, Cepeda J, Kelly SL, Heimer R, Cook R, Altice FL, Litz T, Terlikbayeva A, El-Bassel N, Havarkov D, Fisenka A, Boshnakova A, Klepikov A, Saliuk T, Deshko T, Vickerman P. Costs and impact on HIV transmission of a switch from a criminalisation to a public health approach to injecting drug use in eastern Europe and central Asia: a modelling analysis. Lancet HIV 2022; 9:e42-e53. [PMID: 34895484 PMCID: PMC8762142 DOI: 10.1016/s2352-3018(21)00274-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/16/2021] [Accepted: 10/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND HIV incidence is increasing in eastern Europe and central Asia, primarily driven by injecting drug use. Coverage of antiretroviral therapy (ART) and opioid agonist therapy are suboptimal, with many people who inject drugs (PWID) being incarcerated. We aimed to assess whether use of monies saved as a result of decriminalisation of drug use or possession to scale up ART and opioid agonist therapy could control HIV transmission among PWID in eastern Europe and central Asia. METHODS A dynamic HIV transmission model among PWID incorporating incarceration, ART, and opioid agonist therapy was calibrated to Belarus, Kazakhstan, Kyrgyzstan, and St Petersburg (Russia). Country-specific costs for opioid agonist therapy, ART, and incarceration were collated or estimated. Compared with baseline, the model prospectively projected the life-years gained, incremental costs (2018 euros), and infections prevented over 2020-40 for three scenarios. The decriminalisation scenario removed incarceration resulting from drug use or possession for personal use, reducing incarceration among PWID by 24·8% in Belarus, Kazakhstan, and Kyrgyzstan and 46·4% in St Petersburg; the public health approach scenario used savings from decriminalisation to scale up ART and opioid agonist therapy; and the full scale-up scenario included the decriminalisation scenario plus investment of additional resources to scale up ART to the UNAIDS 90-90-90 target of 81% coverage and opioid agonist therapy to the WHO target of 40% coverage. The incremental cost-effectiveness ratios per life-year gained for each scenario were calculated and compared with country-specific gross domestic product per-capita willingness-to-pay thresholds. Costs and life-years gained were discounted 3% annually. FINDINGS Current levels of incarceration, opioid agonist therapy, and ART were estimated to cost from €198 million (95% credibility interval 173-224) in Kyrgyzstan to €4129 million (3897-4358) in Kazakhstan over 2020-40; 74·8-95·8% of these total costs were incarceration costs. Decriminalisation resulted in cost savings (€38-773 million due to reduced prison costs; 16·9-26·1% reduction in overall costs) but modest life-years gained (745-1694). The public health approach was cost saving, allowing each setting to reach 81% ART coverage and 29·7-41·8% coverage of opioid agonist therapy, resulting in 17 768-148 464 life-years gained and 58·9-83·7% of infections prevented. Results were similar for the full scale-up scenario. INTERPRETATION Cost savings from decriminalisation of drug use could greatly reduce HIV transmission through increased coverage of opioid agonist therapy and ART among PWID in eastern Europe and central Asia. FUNDING Alliance for Public Health, US National Institute of Allergy and Infectious Diseases and National Institute for Drug Abuse, and Economist Intelligence Unit.
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Affiliation(s)
- Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Viktor Ivakin
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, Almaty, Kazakhstan
| | | | - Anna Deryabina
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, Almaty, Kazakhstan
| | - Andrea Low
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | | | - Frederick L Altice
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Taylor Litz
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Assel Terlikbayeva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Nabila El-Bassel
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Denis Havarkov
- Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health, Minsk, Belarus
| | - Alena Fisenka
- Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health, Minsk, Belarus
| | | | | | | | | | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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Rao IJ, Humphreys K, Brandeau ML. Effectiveness of Policies for Addressing the US Opioid Epidemic: A Model-Based Analysis from the Stanford-Lancet Commission on the North American Opioid Crisis. LANCET REGIONAL HEALTH. AMERICAS 2021; 3:100031. [PMID: 34790907 PMCID: PMC8592267 DOI: 10.1016/j.lana.2021.100031] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The U.S. opioid crisis has been exacerbated by COVID-19 and the spread of synthetic opioids (e.g., fentanyl). METHODS We model the effectiveness of reduced prescribing, drug rescheduling, prescription monitoring programs (PMPs), tamper-resistant drug reformulation, excess opioid disposal, naloxone availability, syringe exchange, pharmacotherapy, and psychosocial treatment. We measure life years, quality-adjusted life years (QALYs), and opioid-related deaths over five and ten years. FINDINGS Under the status quo, our model predicts that approximately 547,000 opioid-related deaths will occur from 2020 to 2024 (range 441,000 - 613,000), rising to 1,220,000 (range 996,000 - 1,383,000) by 2029. Expanding naloxone availability by 30% had the largest effect, averting 25% of opioid deaths. Pharmacotherapy, syringe exchange, psychosocial treatment, and PMPs are uniformly beneficial, reducing opioid-related deaths while leading to gains in life years and QALYs. Reduced prescribing and increasing excess opioid disposal programs would reduce total deaths, but would lead to more heroin deaths in the short term. Drug rescheduling would increase total deaths over five years as some opioid users escalate to heroin, but decrease deaths over ten years. Combined interventions would lead to greater increases in life years, QALYs, and deaths averted, although in many cases the results are subadditive. INTERPRETATION Expanded health services for individuals with opioid use disorder combined with PMPs and reduced opioid prescribing would moderately lessen the severity of the opioid crisis over the next decade. Tragically, even with improved public policies, significant morbidity and mortality is inevitable.
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Affiliation(s)
- Isabelle J. Rao
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Keith Humphreys
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Corresponding author. 401 N. Quarry Road, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305-5717
| | - Margaret L. Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
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Hartigan SE, Rogers R, Williams MM, Donson JE. Challenges for the SASSI-4 and InDUC-2R: Positive Impression Management in Offenders with Substance Use Histories. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-021-09909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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