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Economic Overview of Methadone Maintenance Treatment in New Brunswick Timothy Christie, Regional Director, Horizon Health Network Julie Dingwell, Executive.

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Presentation on theme: "Economic Overview of Methadone Maintenance Treatment in New Brunswick Timothy Christie, Regional Director, Horizon Health Network Julie Dingwell, Executive."— Presentation transcript:

1 Economic Overview of Methadone Maintenance Treatment in New Brunswick Timothy Christie, Regional Director, Horizon Health Network Julie Dingwell, Executive Director, AIDS Saint John Bill Reid, Chief, Saint John Police Force

2 Contact Information Dr. Timothy Christie Regional Director, Ethics Services Horizon Health Network Saint John Regional Hospital Saint John, New Brunswick, Canada Phone (506)

3 Outline 1.Historical Development 2.Discovered as a treatment for Addiction 3.Local Data –One-year retention rates –Illicit Drug Use –Crime 4.Economics of Methadone in NB

4 Historical Development

5 History of “va 1082” In 1937 I.G. Farbenkonzein and Faberwerke synthesized formula va 1082 (given the name methadone in 1947) va 1082 was chemically unlike morphine and heroin but it acted on the same receptors. After the war all German patents were expropriated by the allies, particularly the US. In 1947 the “Council on Pharmacy and Chemistry of the American Medical Association” coined the generic name methadone.

6 History of “va 1082” “Since the patent rights of the I.G. Favenkonzein and Faberwerke were no longer protected each pharmaceutical company interested in the formula could by the rights for commercial production of methadone for just one dollar.” –Adanon®, Adolan®, Althose®, Amidone®, –AN-148®, Anadon®, Biodone®, Butalgin®, –Diskets®, Dolamid®, Dolophine®, Dopridol®, –Eptadone®, Heptadon®, Heptalgin®, Heptanal®, –Heptanon®, Ketalgin®, Mephenon®, Metasedin®, –Methadone®, Methadose®, Methox, Miadone®, –Pallidone®, Petalgin®, Phenadone®, Physeptone®, –Sedo Rapide®, Symoron®, Tussol®, Westadone®

7 Methadone as Treatment for Opioid Addiction 1965-Present

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11 Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence (Review) Mattick RP, Breen C, Kimber J, Davoli M The Cochrane Collaboration Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

12 Conclusion “Methadone maintenance treatment can keep people who are dependent on heroin in treatment programs and reduce their use of heroin. Methadone is the most widely used replacement for heroin in medically-supported maintenance or detoxification programs. Several non-drug detoxification and rehabilitation methods are also used to try and help people withdraw from heroin. However the review found that people have withdrawn from trials when they are assigned to a drug-free program. […] These trials show that methadone can reduce the use of heroin in dependent people, and keep them in treatment programs.”

13 Controversy To date, methadone maintenance therapy has been the most systematically studied and most successful, and most politically polarizing, of any pharmacotherapy for the treatment of drug addiction patients. Functional Patients vs Abstinent Patients

14 Issue Social Policy Issues –Untreated opioid addiction –Waitlists MMT Program vs LTHT Approach –Admission –Group and Individual Counselling –Random Urine Testing –Involuntary Discharge

15 One-Year Retention Rates

16 Objective The objective of this study is to determine the one-year retention rate for the Low Threshold/High Tolerance (LTHT) methadone clinic and whether the LTHT approach would be a safe and effective means of managing waitlists in this province.

17 Method The one-year retention rate was determined by collecting data on each patient who received MMT from the clinic between August 04, 2009 and August 04, The total number of patients enrolled in the clinic was compared to the number of patients still in the program after a minimum of one-year of treatment.

18 95% One-Year Retention Rate

19 Summary The one-year retention rate was 95%. There were a total of 179 patients enrolled in the clinic and 170 were receiving treatment after one-year. Of those no longer receiving treatment, three were incarcerated, two were transferred to other care providers, three voluntarily withdrew from the program and one person went into witness protection.

20 Illicit Drug Use

21 Objective The objective of this study is to determine the prevalence of illicit opioid and cocaine use in the LTHT methadone maintenance treatment clinic.

22 Methods A randomly selected retrospective cohort of 84 research participants. The results of six consecutive urine tests for the most recent three months of treatment were compared to the results of the first six consecutive urine tests after entering treatment. Paired t-tests were conducted to determine whether the mean number of positive tests was different between these two time periods and then an effect size was calculated using Cohen’s D. The alpha level was set at p<.05.

23 Patients Time PeriodTime in Treatment Methadone Dose GenderAge N = 84August 2009 – January months (mean) [range 9-18 months] 72.75mg62% Men 38% Women 35.5-years- old 95% CI (15.73,16.67) 95% CI (67.48,78.02mg ) 95% CI (33.26, 37.74)

24 Prevalence of Illicit Opioid Use at Program Entry = 100%

25 Prevalence of Illicit Opioid Use after stabilization on methadone = 44%

26 66.6% increase in the number of people abstaining from illicit opioids.

27 Summary Opioids In general, participants were more likely to test positive for illicit opioids before stabilizing on methadone (mean = 2.88, SE =.19) than after stabilizing on methadone (mean = 0.79, SE =.15), t(83) = , p<.001, Cohen’s D = This decrease in positive tests was statistically significant (p<.001) and the effect size of is considered large.

28 Cocaine Tests

29 Prevalence of cocaine use at program entry = 56%

30 Prevalence of cocaine use after stabilization on methadone = 43%

31 13% increase in the number of people abstaining from cocaine

32 Cocaine Summary Although methadone has no biological effect for cocaine use, participants were more likely to test positive for cocaine before stabilizing on methadone (mean = 2.16, SE =.263) than after stabilizing on methadone (mean = 1.63, SE =.252), t(83) = -2.56, p=.012, Cohen’s D = This decrease in positive cocaine tests was statistically significant (p=.012) and the effect size of is considered small.

33 Suspected Crime

34 Objective The objective of this study is to determine the incidence of crime among a cohort of MMT patients in a low- threshold/high-tolerance methadone clinic located in Saint John, New Brunswick, Canada.

35 Methods A random sample of 92 stable patients receiving MMT at the LTHT clinic. Data on the incidence rate of criminal activity were collected from the Computer Aided Dispatch (CAD) system and the Records Management System (CRIME) of the Saint John Police Force (SJPF) The SJPF categorized the nature of their interactions with citizens into discrete categories, i.e., witness, victim, person reporting, suspect, etc. Based on the nature of these data we considered only interactions where the SJPF “suspected” the research participant of engaging in criminal activity.

36 Methods The date of each interaction was noted and then grouped into six categories: months before entering methadone treatment, months before treatment, 3.<6-months before treatment, 4.<6-months after treatment, months after treatment, months after treatment

37 Methods A Chi-square analysis was performed to identify any statistically significant differences between the category of months before treatment and the other categories. The incidence rate was calculated by including the number of times a research participant was identified as a suspect by the SJPF in a given six-month period, in the numerator. The denominator consisted of the sum of the different times for which each individual was observed.

38 Results Over a three year period this randomly selected cohort of 92 individuals were suspected of committing 688 crimes: –350 during the 18-months before entering MMT –338 during the 18-months after entering MMT.

39 12-18 Before 6-12 Before 6-Before<6-After6-12 After12-18 After Suspect Time/Years44 36 Incidence Rate Per Person Year

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46 Costs

47 Objective The objective of this study is to describe the costs associated with treating a patient with methadone via the LTHT Model

48 Methods Data were gathered on the cost of the following: –Methadone hydrochloride –Laboratory costs –Program costs (including HR) –Pharmacy costs

49 Costs

50 MethadoneLaboratoryProgramPharmacyTotal Individual/Year$127.75$512$953.75$4,288.75$5, Total Clinic/Year$22,100.75$88,576$165,000 $741, $1,017,630.50

51 72% of cost = $4288 per patient per year regardless of what program the patient is in.

52 YearYearly Drug CostPercentage Yearly Dispensing Percentage $1687%$228593% $1997%$261593% $1776%$263594% $1675%$304395% $1785%$357195% $703%$235597% Annual Drug Cost and Dispensing Fee per Patient Year

53 New Brunswick Prescription Drug Program (NBPDP) Methadone for Opioid Dependence Drug CostTotal Dispensing Fees# NBPDP Beneficiaries $.08M$1.09M $.12M$1.58M $.16M$2.38M $.24M$4.37M $.30M$6.00M * $.12M$4.00M1698

54 MethadoneLaboratoryProgramPharmacyTotal Individual/Year$127.75$512$953.75$4,288.75$5, Total Clinic/Year$22,100.75$88,576$165,000 $741, $1,017,630.50

55 72% of cost = $4288 per patient per year regardless of what program the patient is in.

56 Overall Conclusions 1.95% One-Year Retention Rate % achieved abstinence from illicit opioids 3.13% increase in those abstaining from cocaine 4.42% reduction in poly drug use (cocaine and illicit opioids) 5.62% reduction in crime 6.$5, to treat a patient on the LTHT model 7.72% of costs are for Pharmacy dispensing fees 8.PNB currently spends $1,017, to treat 173 people.

57 Thank You!


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