title: Dynamics in the costs of criminality among opioid dependent individuals.
abstract: BACKGROUND
  Research into the avoided crime-related costs associated with methadone maintenance treatment (MMT) is sparse. Our objective was to characterize the dynamics in crime-related costs associated with MMT effectiveness among opioid dependent individuals in Vancouver, Canada.
  
  
  METHODS
  We considered individuals enrolled in a prospective study between December, 2011 and May, 2013. Monthly crime-related costs (2013 CAD) were derived from self-reported criminal activity. On the basis of MMT receipt and illicit opioid use, individuals were classified in mutually exclusive health states: (i) MMT high effectiveness; (ii) MMT low effectiveness; (iii) opioid abstinence; or (iv) relapse. We classified individuals as daily, non-daily or non-stimulant users and controlled for demographic and socio-economic characteristics. A two-part multiple regression model was constructed; the first part modeled non-zero cost probability, the second estimated the level of costs. Avoided costs were estimated for each health state and stratified by stimulant use intensity.
  
  
  RESULTS
  Our study included 982 individuals (median age 47, 38% female) for 2232 observations. Individuals on MMT with high effectiveness incurred lower monthly costs of criminality (avoided costs of $6298; 95% C.I. ($1578, $11,017)), as did opioid abstinent individuals ($6563 ($1564, $11,561)). Avoided costs for daily stimulant users were greater than for non-daily users, both for individuals on MMT with high effectiveness ($12,975 vs. $4125) and opioid abstinent ($12,640 vs. $4814).
  
  
  CONCLUSIONS
  Using longitudinal data on individuals with a history of MMT, we found substantially lower costs of criminality associated with high effect to MMT. Avoided costs were highest among daily stimulant users that were on MMT with high effectiveness or those opioid abstinent.
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Krebs
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada. Electronic address: bnosyk@cfenet.ubc.ca.
authors.forename: Bohdan
authors.initials: B
authors.lastname: Nosyk
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects; D015331:Cohort Studies; D017281:Cost of Illness; D003415:Crime / Q000191:economics*; D057237:Criminals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008691:Methadone / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000191:economics* / Q000379:methods; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone
keywords: Costs of criminality; Methadone maintenance treatment; Opioid use; Relapse; Stimulant use; Treatment outcomes