Research conducted by the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE) in collaboration with the UCLA (University of California Los Angeles) Integrated Substance Abuse Programs, and supported by the National Institutes on Drug Abuse (NIDA), found people receiving immediate access to OAT with methadone generate lower costs to society compared to those initiating treatment with time-limited, medically managed withdrawal (MMW). California’s treatment guidelines require two or more failed attempts at MMW before accessing OAT, which is more stringent than federal regulations. While many clinics receive exemptions to these regulations, MMW remains common practice in California.
“The clinical case for immediate access to OAT has been made – improved health and the reduction in illicit opioid use, relapse and overdose risk, yet MMW remains common practice for people with seeking treatment for opioid use disorders,” says Dr. Bohdan Nosyk, senior author and Associate professor at the BC-CfE and Simon Fraser University. “Our analysis found that savings from allowing immediate access to OAT to all patients would be over $3 billion, with savings as high as $1.2 billion over the next ten 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 OAT in publicly-funded programs in California.
The results show the costs of increased access to OAT are more than offset by reductions in healthcare utilization and crime, and that OAT 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 BC-CfE. “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 OAT 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 per cent 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.
About the British Columbia Centre for Excellence in HIV/AIDS
The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada’s largest HIV/AIDS research, treatment and education facility – nationally and internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. The made-in-BC Treatment as Prevention strategy (TasP®) pioneered by BC-CfE, and supported by UNAIDS since 2011, inspired the ambitious global target for HIV treatment – known as the 90-90-90 Target – to end AIDS as a pandemic by 2030. The BC-CfE is applying TasP® to therapeutic areas beyond HIV/AIDS, including viral hepatitis and addiction, to promote Targeted Disease Elimination as a means to contribute to healthcare sustainability. The BC-CfE works in close collaboration with key stakeholders, including government, health authorities, health care providers, academics, and the community to decrease the health burden of HIV/AIDS, HCV and addictions across Canada and around the world.