Unlimited, immediate access to publicly funded opioid agonist treatment with methadone could save California billions.
Unlimited and immediate access to opioid agonist treatment is more effective than mandated short-term, medically managed withdrawal and will save California billions in health care resources and crime-related costs according to an economic analysis published in the Annals of Internal Medicine.
Research conducted by the British Columbia Centre for Excellence in HIV/AIDS in collaboration with the University of California Los Angeles Integrated Substance Abuse Programs, and supported by the National Institutes on Drug Abuse, found people receiving immediate access to opioid agonist treatment with methadone generate lower costs to society compared to those initiating treatment with time-limited, medically managed withdrawal.
California’s treatment guidelines require two or more failed attempts at medically managed withdrawal before accessing opioid agonist treatment, which is more stringent than federal regulations. While many clinics receive exemptions to these regulations, medically managed withdrawal remains a common practice in California.
“The clinical case for immediate access to (opioid agonist treatment) has been made — improved health and the reduction in illicit opioid use, relapse and overdose risk, yet (medically managed withdrawal) remains common practice for people with seeking treatment for opioid use disorders,” Dr. Bohdan Nosyk, senior author and associate professor at the British Columbia Centre for Excellence and Simon Fraser University, said. “Our analysis found that savings from allowing immediate access to (opioid agonist treatment) to all patients would be over $3 billion, with savings as high as $1.2 billion over the next 10 years from the health care sector alone.”
As part of an ongoing economic analysis of California’s drug treatment programs, the authors analyzed state-level linked administrative data on drug treatment, interactions with the criminal justice system and vital statistics. These analyses were integrated into a computer simulation model tracking the lifetime costs and benefits of people accessing the treatment in publicly-funded programs in California.
The results show the costs of increased access to opioid agonist treatment are more than offset by reductions in healthcare utilization and crime, and that the treatment also reduces mortality, HIV incidence, and incarceration.
“The scientific and medical community recognize that placing an arbitrary limit on the duration of treatment is inconsistent with the disease course of opioid use disorder,” says Emanuel Krebs, lead author of the study, health economist at the British Columbia Centre for Excellence. “Mandated short-term treatment doesn’t help people desperately in need of unencumbered access to treatment, and it doesn’t serve California taxpayers very well either. We know (opioid agonist treatment) is better for public health, now we have evidence it’s better for the public purse.”
The opioid epidemic is a public health priority in the United States with the number of Americans with opioid use disorder increasing from 1.4 million to nearly 2.4 million in 2015. Nearly 80 percent of people with opioid use disorder did not receive treatment in 2015, with the cost of opioid use disorder being cited as a barrier to access.
This study is supported by NIH (National Institutes of Health) grants DA031727, DA032551, and DA016383.
(Sources: British Columbia Centre for Excellence in HIV/AIDS; Photo Credit: AP Photo/Carla K. Johnson-File)