Overview of Approaches, Cost Effectiveness, and Outcomes for Substance Use Disorder Treatment New Hampshire House Finance Presentation March 16, 2015

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1 Overview f Appraches, Cst Effectiveness, and Outcmes fr Substance Use Disrder Treatment New Hampshire Huse Finance Presentatin March 16, 2015 The infrmatin in this dcument has been accessed frm the Natinal Institute n Drug Abuse (NIDA), its research partners, and ther literature. Cmparative data are prvided fr ther chrnic cnditins that have a behavir cmpnent invlved in the develpment f the disrder and the efficacy f treatment as cmparative cntext. Fr example, diabetes ften results frm a cmbinatin f inherited risk factrs, ne s envirnment and culture (the eating and activity habits f ne s family r cmmunity), and an individual s nutritin and activity chices, just as addictin ften results frm inherited risk factrs, an envirnment that may pse risk fr using substances (e.g. the substance use f family r friends), and an individual s early chices t use a substance such as alchl r piids. Overall, natinal studies have demnstrated that treatment utcmes are n par r better than treatment utcmes fr ther chrnic bipsychscial cnditins. As the graph belw indicates, relapse ccurs amng 40-60% f patients wh received treatment fr drug addictin, cmpared t 50-70% wh relapse relative t hypertensin and asthma and cmpared t 30 t 50% t relapse fr diabetes 1. Furthermre, research shws that relapse rates are influenced by the severity and duratin f ne s addictin, underscring the imprtance f early treatment f adequate duratin. 1

2 Belw is a sampling f research demnstrating the efficacy f treatment appraches fr substance use disrders. Type Research Findings Treatment Appraches Screening, Brief Interventin and Referral t Treatment (SBIRT) There is substantial evidence fr the effectiveness f brief interventins fr harmful drinking when delivered by a physician r ther qualified health prfessinal (Bien et al, 1993; Kahan et al, 1995; Wilk et al, 1993) and a grwing bdy f literature shwing the effectiveness f SBIRT fr risky drug use (Madras et al, 2008; Saitz et al, 2010; Bernstein et al.,2005) 2 Medicatins Methadne In a review f multiple research trials which all were randmized clinical and tw were duble-blind, findings frm research n 1,969 participants were analyzed. Methadne appeared statistically significantly mre effective than nn-pharmaclgical appraches in retaining patients in treatment and in the suppressin f herin use as measured by self reprt and urine/hair analysis. Authrs cncluded that methadne is an effective maintenance therapy interventin fr the treatment f herin dependence as it retains patients in treatment and decreases herin use better than treatments that d nt utilize piid replacement therapy. 3 Buprenrphine Behaviral Buprenrphine cmbined with nalxne tapering and biweekly behaviral cunseling Cgnitive Behaviral Therapy (CBT) 53.2% f piid dependent had urine screens negative fr piids in lnger term buprenrphine and cunseling regimen cmpared t 35.2% f patients tapered fr 3 weeks after a 6 week regimen 4 63 percent were abstinent at the 5-week mark, and 50 percent were still piid-abstinent at the end f the 12-week trial 5 A study f adlescents identified thrugh primary care screenings(sbirt) as misusing alchl and marijuana were prvided a brief treatment f tw 60 minute CBT sessins 7-10 days apart. Treated adlescents reprted using alchl n fewer f the past 90 days, while the untreated adlescents reprted increased days f alchl use. Treated and untreated Methadne maintenance therapy versus n piid replacement therapy fr piid dependence (Review) 32 Cpyright 2009 The Cchrane Cllabratin. Published by Jhn Wiley & Sns, Ltd. 4 Fiellin, D.A; Schttenfeld, R.S; et al. Primary Care Based Buprenrphine Taper vs Maintenance Therapy fr Prescriptin Opiid Dependence: A Randmized Clinical Trial. JAMA Intern Med. 2014;174(12): di: /jamainternmed , 5 Sigmn, S.C.; Dunn, K.E.; Saulsgiver, K. et al. A randmized, duble-blind evaluatin f buprenrphine taper duratin in primary prescriptin piid abusers. JAMA Psychiatry. 70(12): , 2013.

3 Cst Effectiveness Mtivatinal Incentives/Cntingency Management(CM) Overall Type Research Findings yuths bth reprted fewer days f cannabis use during the past 90 days, but the treatment grup s reductins were significantly greater. Treated yuths reprted fewer symptms f alchl abuse and dependence during the past 60 days t a much greater degree than untreated. Als at the 6-mnth fllwup, half f the treated adlescents reprted having been abstinent frm marijuana fr the past 3 mnths, and half reprted having been abstinent frm alchl fr the past 3 mnths. 6 Cmpared t Incarceratin In a meta-analysis f 47 studies researching the effectiveness f mtivatinal incentives (cntingency management) fund this apprach t be effective in treating piate use and ccaine use (d = 0.66). Authrs cncluded that CM is amng the mre effective appraches t prmting abstinence during the treatment f substance use disrders. CM imprves the ability f clients t remain abstinent, thereby allwing them t take fuller advantage f ther clinical treatment cmpnents. 7 Accrding t several cnservative estimates, every dllar invested in addictin treatment prgrams yields a return f between $4 and $7 in reduced drug-related crime, criminal justice csts, and theft. When savings related t healthcare are included, ttal savings can exceed csts by a rati f 12 t 1. Majr savings t the individual and t sciety als stem frm fewer interpersnal cnflicts; greater wrkplace prductivity; and fewer drug-related accidents, including verdses and deaths. 8 A study f Califrnia s SACPA prgram t divert eligible drug crime ffenders t treatment rather than jail fund a net savings f $2,300 per ffender per year. 9 6 Winters, K.C., et al. Brief interventin fr drug-abusing adlescents in a schl setting: Outcmes and mediating factrs. Jurnal f Substance Abuse Treatment 42(3): , Prendergast M, et al. Cntingency management fr treatment f substance use disrders: a meta-analysis. Addictin Nv;101(11): Anglin, M.D., et al. Offender diversin int substance use disrder treatment: the ecnmic impact f Califrnia s Prpsitin 36. American Jurnal f Public Health 103(6): , 2013.

4 The infrmatin in the table abve demnstrates that there is sufficient data that articulate the efficacy f and cst-savings fr the treatment f substance use disrders such as addictin. Questins and cmments fr the cmmittee: - Hw many times have cancer researchers r behaviral health services been asked t cme and defend their treatment utcmes? - If it were in yur pwer t defund cancer treatment and behaviral health benefits such as psychtherapy, wuld yu? If yu were given prf that cancer treatment and behaviral health benefits nly wrked 50% f the time? And 70% f the time but nly if caught and treated early and fr as lng as necessary fr a 5 year remissin perid? - Yu d nt fr these ther cnditins because f the histrical segregatin f substance use disrders frm the rest f physical and bipsychscial disrders such as diabetes. This segregatin is the result f the stigma assciated with alchl and drug abuse and dependence. It is why the federal gvernment intervened and develped blck grants t states t treat substance use disrders and mental health disrders separately because they were nt being treated by the medical field/prfessin. This segregatin is evident in each state s ability t chse whether its Medicaid prgrams include substance use disrder treatment r nt. Imagine if we were able t chse whether childhd cancers were ging t be cvered fr the pr. It is evident in the discussin yu have befre yu tday. The histrical stigma and assciated shame that cripples ur ability t treat this disease will nly be lessened by ur hnrable duty and decisins mving frward. - Therefre, this cmmittee has n pprtunity t demand treatment efficacy and utcmes fr any ther disease. I ask yu t stp ding it fr addictin. - Make an investment in everyne s family nw. D until this disease is treated like any ther with widespread preventin effrts, early interventin prtcls, a range f treatments and lng-term remissin supprt. - Dn t penny pinch a crisis because yu can. Dn t penny pinch a disease that has nw grwn t ne that takes the life f a NH resident every day in NH. Every day.

5 - When these services d nt exist n par with the preventin and treatment we have fr cancer and diabetes and depressin and anything else, we are turning ur backs n ur neighbrs and ur cmmunities that are suffering it is the lwest and mst devastating relinquishing f ur pwer t the ravages f stigma and shame fr yet anther generatin. - I sit befre yu t ask yu in yur rle as gatekeepers f the resurces that are desperately needed t cmbat this epidemic t d the cnscinable thing and ensure that these resurces exist, that they are substantial, and that they are maintained. - Our lives and the fabric f ur families, businesses and cmmunities demand it. Thank yu fr yur time.