Estimating State Transitions for Opioid Use Disorders

Emanuel Krebs, Jeong E. Min, Elizabeth Evans, Libo Li, Lei Liu, David Huang, Darren Urada, Thomas Kerr, Yih-Ing Hser and Bohdan Nosyk

Medical Decision Making, 2017, vol. 37, issue 5, 483-497

Abstract: Aim. The aim was to estimate transitions between periods in and out of treatment, incarceration, and legal supervision, for prescription opioid (PO) and heroin users. Methods. We captured all individuals admitted for the first time for publicly funded treatment for opioid use disorder (OUD) in California (2006 to 2010) with linked mortality and criminal justice data. We used Cox proportional hazards and competing risks models to assess the effect of primary PO use (v. heroin) on the hazard of transitioning among 5 states: (1) opioid detoxification treatment; (2) opioid agonist treatment (OAT); (3) legal supervision (probation or parole); (4) incarceration (jail or prison); and (5) out-of-treatment. Transitions were conditional on survival, and death was modeled as an absorbing state. Results. Both primary PO (n = 11,733) and heroin (n = 19,926) users spent most of their median 2.3 y of observation out of treatment. Primary PO users were significantly younger (median age 30 v. 34 y), and a higher percentage were female (43.1% v. 31.5%; P

Keywords: state transitions; prescription opioids; heroin; opioid use disorder treatment; criminal justice; subdistribution hazard model (search for similar items in EconPapers)
Date: 2017
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:37:y:2017:i:5:p:483-497

DOI: 10.1177/0272989X16683928

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