title: Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publicly-funded facilities in California, USA: 1991-2012.
abstract: BACKGROUND
  California treats the largest population of opioid dependent individuals in the USA and is among a small group of states that applies regulations for opioid treatment that are more stringent than existing federal regulations. We aim to characterize changes in patient characteristics and treatment utilization over time, and identify determinants of successful completion of detoxification and MMT retention in repeated attempts.
  
  
  METHODS
  State-wide administrative data was obtained from California Outcome Measurement System during the period: January 1st, 1991-March 31st, 2012. Short-term detoxification treatment and long-term maintenance treatment, primarily with methadone, was available to study participants. Mixed effects regression models were used to define determinants of successful completion of the detoxification treatment protocol (as classified by treatment staff) and duration of maintenance treatment.
  
  
  RESULTS
  The study sample consisted of 237,709 unique individuals and 885,971 treatment episodes; 837% were detoxification treatment episodes in 1994, dropping to 40.5% in 2010. Among individuals accessing only detoxification, the adjusted odds of success declined with each successive attempt (vs. 1st attempt: 2nd: OR: 0.679; 95% CI (0.610, 0.755); 3rd: 0.557 (0.484, 0.641); 4th: 0.526 (0.445, 0.622); 5th: 0.407 (0.334, 0.497); ≥6th: 0.339 (0.288, 0.399). For those ever accessing maintenance treatment, later subsequent attempts were longer in duration, and those with two or more prior attempts at detoxification had marginally longer subsequent maintenance episodes (hazard ratio: 0.97; 95% CI: 0.95, 0.99). Finally, only 10.9% of all detoxification episodes were followed by admission into maintenance treatment within 14 days.
  
  
  CONCLUSIONS
  This study has revealed high rates of detoxification treatment for opioid dependence in California throughout the study period, and decreasing odds of success in repeated attempts at detoxification.
authors.affiliation: BC Centre for Excellence in HIV/AIDS, 613-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Faculty of Health Sciences, Simon Fraser University, Canada; UCLA Integrated Substance Abuse Programs, USA. Electronic address: bnosyk@cfenet.ubc.ca.
authors.forename: Bohdan
authors.initials: B
authors.lastname: Nosyk
authors.affiliation: UCLA Integrated Substance Abuse Programs, USA.
authors.forename: Libo
authors.initials: L
authors.lastname: Li
authors.affiliation: UCLA Integrated Substance Abuse Programs, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Evans
authors.affiliation: UCLA Integrated Substance Abuse Programs, USA.
authors.forename: Darren
authors.initials: D
authors.lastname: Urada
authors.affiliation: UCLA Integrated Substance Abuse Programs, USA.
authors.forename: David
authors.initials: D
authors.lastname: Huang
authors.affiliation: BC Centre for Excellence in HIV/AIDS, 613-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: UCLA Integrated Substance Abuse Programs, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Rawson
authors.affiliation: UCLA Integrated Substance Abuse Programs, USA.
authors.forename: Yih-Ing
authors.initials: YI
authors.lastname: Hser
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California; D003156:Community Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000191:economics* / Q000706:statistics & numerical data*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009294:Narcotics; D008691:Methadone
keywords: Detoxification treatment; Longitudinal; Methadone treatment; Opioid dependence
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