1
|
Bórquez I, Cerdá M, González-Santa Cruz A, Krawczyk N, Castillo-Carniglia Á. Longitudinal trajectories of substance use disorder treatment use: A latent class growth analysis using a national cohort in Chile. Addiction 2024; 119:753-765. [PMID: 38192124 DOI: 10.1111/add.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/16/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND AND AIMS Longitudinal studies have revealed that substance use treatment use is often recurrent among patients; the longitudinal patterns and characteristics of those treatment trajectories have received less attention, particularly in the global south. This study aimed to disentangle heterogeneity in treatment use among adult patients in Chile by identifying distinct treatment trajectory groups and factors associated with them. DESIGN National-level registry-based retrospective cohort. SETTING AND PARTICIPANTS Adults admitted to publicly funded substance use disorder treatment programs in Chile from November 2009 to November 2010 and followed for 9 years (n = 6266). MEASUREMENTS Monthly treatment use; type of treatment; ownership of the treatment center; discharge status; primary substance used; sociodemographic. FINDINGS A seven-class treatment trajectory solution was chosen using latent class growth analysis. We identified three trajectory groups that did not recur and had different treatment lengths: Early discontinuation (32%), Less than a year in treatment (19.7%) and Year-long episode, without recurrence (12.3%). We also identified a mixed trajectory group that had a long first treatment or two treatment episodes with a brief time between treatments: Long first treatment, or immediate recurrence (6.3%), and three recurrent treatment trajectory groups: Recurrent and decreasing (14.2%), Early discontinuation with recurrence (9.9%) and Recurrent after long between treatments period (5.7%). Inpatient or outpatient high intensity (vs. outpatient low intensity) at first entry increased the odds of being in the longer one-episode groups compared with the Early discontinuation group. Women had increased odds of belonging to all the recurrent groups. Using cocaine paste (vs. alcohol) as a primary substance decreased the odds of belonging to long one-episode groups. CONCLUSIONS In Chile, people in publicly funded treatment for substance use disorder show seven distinct care trajectories: three groups with different treatment lengths and no recurring episodes, a mixed group with a long first treatment or two treatment episodes with a short between-treatment-episodes period and three recurrent treatment groups.
Collapse
Affiliation(s)
- Ignacio Bórquez
- Center for Opioid Epidemiology and Policy (COEP), Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy (COEP), Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Andrés González-Santa Cruz
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
- Society and Health Research Center and School of Public Health, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile
- School of Public Health, Universidad de Chile, Santiago, Chile
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy (COEP), Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Álvaro Castillo-Carniglia
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
- Society and Health Research Center and School of Public Health, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile
| |
Collapse
|
2
|
Mateo Pinones M, González-Santa Cruz A, Castillo-Carniglia A, Bond C, Payne J, McGee TR. Substance use treatment completion and criminal justice system contact in Chile: A retrospective, linked data cohort study. Addiction 2024. [PMID: 38532650 DOI: 10.1111/add.16488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/25/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND AIMS Substance use treatment (SUT) has shown to be effective in reducing self-reported offending; however, the association between SUT completion and criminal justice system (CJS) contact has been underexplored, especially in Latin America. This study aimed to estimate the association between SUT completion status and (1) any subsequent CJS contact and (2) CJS contact leading to imprisonment, at 1, 3 and 5 years post-discharge, in Chile. DESIGN Retrospective cohort study using multivariable survival analysis based on linked administrative data from 2010 to 2019. SETTING This study took place in Chile, where SUT is available at no cost through Chile's publicly funded health-care, and is provided in outpatient and inpatient modalities in public and private centres. PARTICIPANTS A total of 70 854 individuals received their first SUT from 2010 to 2019. They were mainly males (76.3%), and their main substance used at admission was cocaine paste (39.2%). MEASUREMENTS SUT completion status included completion, late dropout (≥ 3 months) and early dropout (< 3 months). Outcomes were (1) any CJS contact and (2) CJS contact leading to imprisonment after baseline treatment. We estimated the association between treatment completion and CJS contact through flexible parametric Royston-Parmar models while adjusting for several covariates. FINDINGS Those who completed SUT (27.2%) were less likely to have any CJS contact at 5 years post-SUT compared with those who dropped out late [with a gap of -9.5%, 95% confidence interval (CI) = -8.7, -10.3] and early (-11.2%, 95% CI = -10.1, -12.3). Also, those who completed SUT were less likely to have CJS contact leading to imprisonment at 5 years post-SUT compared with those who dropped out late (-2.6%, 95% CI = -2.2, -3.1) and early (-4.0%, 95% CI = -3.3, -4.6). These differences were also observed at 1 and 3 years post-SUT for each outcome. CONCLUSIONS In Chile, completion of substance use treatment appears to be associated with lower probabilities of both any criminal justice system contact and contact leading to imprisonment.
Collapse
Affiliation(s)
- Mariel Mateo Pinones
- School of Criminology and Criminal Justice, Griffith University, Brisbane, Australia
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
| | - Andrés González-Santa Cruz
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
- Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile
- School of Public Health, Universidad de Chile, Santiago, Chile
| | - Alvaro Castillo-Carniglia
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
- Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile
| | - Christine Bond
- School of Criminology and Criminal Justice, Griffith University, Brisbane, Australia
| | - Jason Payne
- School of Criminology and Criminal Justice, Griffith University, Brisbane, Australia
| | - Tara Renae McGee
- School of Criminology and Criminal Justice, Griffith University, Brisbane, Australia
| |
Collapse
|
3
|
Maturana JRT, Cruz AGS, Rocha-Jiménez T, Castillo-Carniglia Á. Does substance use disorder treatment completion reduce the risk of treatment readmission in Chile? Drug Alcohol Depend 2023; 248:109907. [PMID: 37156193 DOI: 10.1016/j.drugalcdep.2023.109907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Recovery from substance use disorders (SUD) often entails multiple treatment episodes, which clashes with a context of a treatment system with limited resources and long waiting. Treatment retention and completion have been pointed out as key elements for sustainable achievement; however, most of the evidence generated focuses on opioids and injected substances, which is hardly transferable to the Latin American context. OBJECTIVES This study aims to estimate the effect of SUD treatment completion on the risk of being readmitted to a SUD treatment in Chile. METHODS We conducted a retrospective analysis on a database of 107,559 treatment episodes from 85,048 adult patients admitted to SUD treatment during 2010-2019 in Chile. We adjusted two separate Prentice Williams and Petersen Gap Time models, to explore the association between treatment completion (vs. non-completion) and up to the third treatment readmission among residential and ambulatory modalities while controlling for time-varying covariates. To examine whether the effect of treatment completion differs between events, we included an interaction term with the stratification variable. RESULTS We found that completing the treatment cuts readmission risk for the first event by 17% (Average Hazard Ratio [95% CI] = 0.83 [0.78, 0.88]) and by 14% for the second entry (Average Hazard Ratio [95% CI] = 0.86 [0.78, 0.94]) in ambulatory treatments. We did not find evidence that completing a treatment reduces the readmission risk for residential treatments or third attempts in ambulatory ones. CONCLUSION Treatment completion was associated with benefits in cutting readmission risk for the first and second episodes in ambulatory treatments among Chilean adults. It is important to explore different mechanisms than treatment retention for residential treatments.
Collapse
Affiliation(s)
- José Ruiz-Tagle Maturana
- Programa de Doctorado en Políticas Públicas, Universidad Mayor, Santiago, Chile; Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile; Fundación Instituto Profesional Duoc UC, Santiago, Chile.
| | - Andrés González-Santa Cruz
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile; Society and Health Research Center, School of Psychology, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile; School of Public Health, Universidad de Chile, Santiago, Chile
| | - Teresita Rocha-Jiménez
- Society and Health Research Center, School of Psychology, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile; Millennium Nucleus on Sociomedicine (SocioMed), Chile
| | - Álvaro Castillo-Carniglia
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile; Society and Health Research Center, School of Psychology, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile; Millennium Nucleus on Sociomedicine (SocioMed), Chile
| |
Collapse
|
4
|
Mateo Pinones M, González-Santa Cruz A, Portilla Huidobro R, Castillo-Carniglia A. Evidence-based policymaking: Lessons from the Chilean Substance Use Treatment Policy. International Journal of Drug Policy 2022; 109:103860. [DOI: 10.1016/j.drugpo.2022.103860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 11/15/2022]
|
5
|
Gajardo AI, Wagner TD, Howell KD, González-Santa Cruz A, Kaufman JS, Castillo-Carniglia A. Effects of 2019's social protests on emergency health services utilization and case severity in Santiago, Chile: a time-series analysis. Lancet Reg Health Am 2021; 5:100082. [PMID: 36776456 PMCID: PMC9903909 DOI: 10.1016/j.lana.2021.100082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 10/19/2022]
Abstract
Background On October 18th, 2019, protestors gathered across Chile to call for social equity, resulting in widespread civil unrest and violent confrontation with the police. In this study, we quantify the effects of the 2019 Chilean protests on emergency health services utilization and inpatient admission in Santiago. Methods We used weekly emergency department (ED) admissions (2015-2019) from three large public hospitals near the focal point of protests in Santiago. The exposure period was from October 18th to December 31st, 2019. The outcomes were the number of weekly consultations and hospitalizations by trauma and respiratory causes and the proportion of hospitalizations among consultants per 1,000. We implemented Bayesian structural time series models to calculate the absolute and relative effects and 95% credible intervals (CrI). Findings During the first ten weeks of protests ED consultations declined on average by 14% for trauma (95%CrI: -40·2%, 11·5%) and 30% for respiratory causes (95%CrI: -89·4%, 30·2%), 7% for respiratory hospitalizations (95%CrI: -43·6%, 30·8%); however, none of these three results were statistically distinguishable from the null. Trauma hospitalizations, on the other hand, increased by 15% (95%CrI: 4·0%, 26·4%), and the proportion of hospitalizations per consultations increased by 40% for trauma (95%CrI: 13·1%, 68·0%) and 59% for respiratory causes (95%CrI: 29·4%, 87·9%). Interpretation The 2019 Chilean protests affected the use of emergency health services by increasing the trauma hospitalizations and the case hospitalization ratio per 1,000 consultations for trauma and respiratory causes. Crowd-control protocols must be reviewed to prevent the negative effects of civil unrest.
Collapse
Affiliation(s)
- Abraham I.J. Gajardo
- Intensive Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Universidad de Chile. Dr. Carlos Lorca Tobar 999, Independencia, Santiago, Chile
| | - Thomas D. Wagner
- Vagelos College of Physicians & Surgeons, Columbia University. 630 W 168th St, New York, NY 10032, USA
| | - Kristina Devi Howell
- Mailman School of Public Health, Columbia University. 722 W 168th St, New York, NY 10032, USA
| | - Andrés González-Santa Cruz
- Society and Health Research Center and School of Public Health, Universidad Mayor, Chile. Badajoz 130, Las Condes, Santiago, Chile
| | - Jay S. Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University. 1020 Pine Avenue West, Montreal, QC H3A1A2, Canada
| | - Alvaro Castillo-Carniglia
- Society and Health Research Center and School of Public Health, Universidad Mayor, Chile. Badajoz 130, Las Condes, Santiago, Chile,Department of Population Health, New York University Grossman School of Medicine. 180 Madison Avenue, New York, NY 10016, USA,Corresponding author: Alvaro Castillo-Carniglia, Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Chile. Badajoz 130, Suite 1305, Las Condes, Santiago, Chile. Phone: +56.2.2518.9800
| |
Collapse
|
6
|
Castillo-Carniglia A, Cruz AGS, Cerdá M, Delcher C, Shev AB, Wintemute GJ, Henry SG. Corrigendum to "Changes in opioid prescribing after implementation of mandatory registration and proactive reports within California's prescription drug monitoring program" [Drug Alcohol Depend. 218 (2021) 108405]. Drug Alcohol Depend 2021; 221:108606. [PMID: 33611026 PMCID: PMC8045981 DOI: 10.1016/j.drugalcdep.2021.108606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center, Universidad Mayor, Chile; School of Public Health, Universidad Mayor, Chile; Department of Population Health, New York University, United States.
| | | | - Magdalena Cerdá
- Department of Population Health, New York University,
United States
| | - Chris Delcher
- Department of Pharmacy Practice and Science, University of
Kentucky, United States
| | - Aaron B. Shev
- Violence Prevention Research Program, University of
California, Davis, United States
| | - Garen J. Wintemute
- Violence Prevention Research Program, University of
California, Davis, United States
| | - Stephen G. Henry
- Department of Internal Medicine, University of California,
Davis, United States,Center for Healthcare Policy and Research, University of
California, Davis, United States
| |
Collapse
|
7
|
Castillo-Carniglia A, González-Santa Cruz A, Cerdá M, Delcher C, Shev AB, Wintemute GJ, Henry SG. Changes in opioid prescribing after implementation of mandatory registration and proactive reports within California's prescription drug monitoring program. Drug Alcohol Depend 2021; 218:108405. [PMID: 33234299 PMCID: PMC7750250 DOI: 10.1016/j.drugalcdep.2020.108405] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND In 2016, California updated its prescription drug monitoring program (PDMP), adding two key features: automated proactive reports to prescribers and mandatory registration for prescribers and pharmacists. The effects of these changes on prescribing patterns have not yet been examined. We aimed to evaluate the joint effect of these two PDMP features on county-level prescribing practices in California. METHODS Using county-level quarterly data from 2012 to 2017, we estimated the absolute change associated with the implementation of these two PDMP features in seven prescribing indicators in California versus a control group comprising counties in Florida and Washington: opioid prescription rate per 1000 residents; patients' mean daily opioid dosage in milligrams of morphine equivalents[MME]; prescribers' mean daily MME prescribed; prescribers' mean number of opioid prescriptions per day; percentage of patients getting >90 MME/day; percentage of days with overlapping prescriptions for opioids and benzodiazepines; multiple opioid provider episodes per 100,000 residents. RESULTS Proactive reports and mandatory registration were associated with a 7.7 MME decrease in patients' mean daily opioid dose (95 %CI: -11.4, -2.9); a 1.8 decrease in the percentage of patients prescribed high-dose opioids (95 %CI: -2.3, -0.9); and a 6.3 MME decrease in prescribers' mean daily dose prescribed (95 %CI: -10.0, -1.3). CONCLUSIONS California's implementation of these two PDMP features was associated with decreases in the total quantity of opioid MMEs prescribed, and indicators of patients prescribed high-dose opioids compared to states that had PDMP's without these features. Rates of opioid prescribing and other high-risk prescribing patterns remained unchanged.
Collapse
Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center, Universidad Mayor, Chile; School of Public Health, Universidad Mayor, Chile; Department of Population Health, New York University, United States.
| | | | - Magdalena Cerdá
- Department of Population Health, New York University, United States
| | - Chris Delcher
- Department of Pharmacy Practice and Science, University of Kentucky, United States
| | - Aaron B Shev
- Violence Prevention Research Program, University of California, Davis, United States
| | - Garen J Wintemute
- Violence Prevention Research Program, University of California, Davis, United States
| | - Stephen G Henry
- Department of Internal Medicine, University of California, Davis, United States; Center for Healthcare Policy and Research, University of California, Davis, United States
| |
Collapse
|