- Email: [email protected]
Gender differences in smoking and treatment outcome among opioid-maintained smokers
Abstracts / Drug and Alcohol Dependence 146 (2015) e34–e117
Financial support: This research was supported by NIH grants R01DA03890 and T32DA007209. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.476 Managing substance use treatment in private U.S. health plans Elizabeth L. Merrick, Constance M. Horgan, Sharon Reif, Amity Quinn, Maureen Stewart, Deborah W. Garnick, Dominic Hodgkin, Ann-Marie Mateucci Institute for Behavioral Health, Heller School, Brandeis University, Waltham, MA, United States Aims: Health strategies to manage utilization of substance use disorder (SUD) treatment may impact treatment access and delivery. This study provides national estimates of health plans’ management strategies. Methods: Data are from a nationally representative survey of private U.S. health plans in 2010 (N = 351 plans, with 939 products; 89% response rate). For each of the three most commonly purchased insurance products, respondents reported on availability of information to enrollees seeking treatment, prior and continuing authorization requirements, medical necessity criteria, and waiting time standards. Results are weighted to provide national estimates. Results: In online provider directories, nearly 90% of health plan products include providers’ specialized expertise, but only 25% include provider performance on satisfaction or quality measures. Only 5% of products required prior authorization for outpatient SUD care. However, 76% required authorization to continue outpatient treatment. Over 90% of products required prior and continuing authorization for higher levels of care. ASAM placement and selfdeveloped criteria were the most common criteria used for prior authorization. Medical necessity criteria were made available to providers and enrollees upon request and denial of services by over 90% of products. Almost all products had formal standards to limit waiting time for routine and urgent treatment, but one-third did not have such standards for detoxification services. Patient surveys and complaint analysis were common methods to monitor wait time. Conclusions: Findings indicate plans use a range of techniques to manage care, but prior authorization, a long-standing technique, was seldom required for outpatient SUD care. Understanding utilization management is of particular interest in the wake of federal parity legislation that curtails the use of more stringent management for behavioral health than is imposed for other medical care. Financial support: NIDA (R01 DA029316) and NIAAA (R01 AA010869). http://dx.doi.org/10.1016/j.drugalcdep.2014.09.477 Gender differences in smoking and treatment outcome among opioid-maintained smokers Andrew C. Meyer, Mollie E. Patrick, Sarah H. Heil, Stephen T. Higgins, Stacey C. Sigmon University of Vermont, Burlington, VT, United States Aims: Prior studies have suggested that gender differences may exist in the general population of smokers, with males often presenting with greater nicotine dependence yet showing better treatment response than females. Less is known about possible gender differences in hard-core subgroups of smokers, such as substance abusers. The present secondary analysis examined
e39
this question in opioid-maintained smokers receiving a behavioral intervention to promote smoking abstinence. Methods: Opioid-maintained smokers received a brief intervention aimed at establishing initial smoking abstinence and included daily visits, biochemical verification of smoking status via breath carbon monoxide and urinary cotinine, and financial incentives contingent upon abstinence. Participants were dichotomized based on gender, and differences in intake characteristics and treatment outcomes were analyzed. Results: Participants (52 males, 68 females) were 33 yrs old and had 12 yrs education. Males smoked more cigarettes per day (20 vs. 17 cigs/day; p = .03), had higher urinary cotinine levels (1537 vs. 1240 ng/ml; p = .01) and scored higher on the Fagerstrom Test for Nicotine Dependence (5.7 vs. 4.8; p = .02) than females, respectively. Males also showed less intention to smoke on the Questionnaire on Smoking Urges (35.3 vs. 45.1; p = .003). With regard to treatment response, males achieved significantly greater smoking abstinence, submitting 61% smoking-negative samples vs. 54% in females (p = .004). In addition to these primary outcomes, we will also examine gender differences in nicotine withdrawal and craving for inclusion in this June 2014 presentation. Conclusions: Consistent with prior studies in the general smoker population, opioid-maintained males exhibited greater nicotine dependence yet responded better to an intervention offering abstinence-contingent financial incentives. These data suggest that gender differences may also exist in substance abusers and extend these findings to opioid-dependent smokers receiving an empirically supported behavioral intervention. Financial support: R01 DA019550, T32 DA007242. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.478 Longitudinal gender differences in HIV and criminal justice outcomes Jaimie P. Meyer, J. Cepeda, F.L. Altice Yale, New Haven, CT, United States Aims: Inform gender-specific HIV interventions among criminal justice (CJ) populations by evaluating gender differences in HIV and CJ outcomes. Methods: Longitudinal CJ, pharmacy, and laboratory databases were linked in a retrospective cohort of HIV+ prisoners on ART. Gender differences were quantified by type of criminal offenses, incarceration periods, and HIV treatment outcomes. Logistic regression models identified correlates of viral suppression (VS; HIV-1 RNA < 400) among women with p < 0.05 being statistically significant (*). Results: Among 1089 HIV+ prisoners on ART, compared to 866 men (1620 incarceration periods), the 223 women (461 incarceration periods) were more likely to be younger (mean 40.2 vs 43.3 years*), white (30.9% vs. 17.2%*), have medical insurance (51.6% vs 9.1%*), have shorter incarceration periods (mean 181.0 vs 327.2 days*) and commit more non-violent misdemeanors (58.0% vs 46.0%*) and public order offenses (44.1% vs 32.1%*). During incarceration periods, women were more likely than men to receive antidepressants (69.1% vs 41.3%*), medication-assisted therapy for opioid dependence (17.5% vs 10.4%*) and achieve VS before release (80.0% vs 68.7%*). Upon CJ entry, one-third of women had VS, correlating with older age (aOR 1.08, 95% CI 1.02–1.14), receiving treatment for other comorbidities, and prescribed single fixed-dose ART combinations (aOR 2.28, 95% CI 1.02–5.13). Conclusions: In the largest contemporary cohort of HIV+ prisoners on ART, women’s incarceration and HIV treatment outcomes
Financial support: This research was supported by NIH grants R01DA03890 and T32DA007209. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.476 Managing substance use treatment in private U.S. health plans Elizabeth L. Merrick, Constance M. Horgan, Sharon Reif, Amity Quinn, Maureen Stewart, Deborah W. Garnick, Dominic Hodgkin, Ann-Marie Mateucci Institute for Behavioral Health, Heller School, Brandeis University, Waltham, MA, United States Aims: Health strategies to manage utilization of substance use disorder (SUD) treatment may impact treatment access and delivery. This study provides national estimates of health plans’ management strategies. Methods: Data are from a nationally representative survey of private U.S. health plans in 2010 (N = 351 plans, with 939 products; 89% response rate). For each of the three most commonly purchased insurance products, respondents reported on availability of information to enrollees seeking treatment, prior and continuing authorization requirements, medical necessity criteria, and waiting time standards. Results are weighted to provide national estimates. Results: In online provider directories, nearly 90% of health plan products include providers’ specialized expertise, but only 25% include provider performance on satisfaction or quality measures. Only 5% of products required prior authorization for outpatient SUD care. However, 76% required authorization to continue outpatient treatment. Over 90% of products required prior and continuing authorization for higher levels of care. ASAM placement and selfdeveloped criteria were the most common criteria used for prior authorization. Medical necessity criteria were made available to providers and enrollees upon request and denial of services by over 90% of products. Almost all products had formal standards to limit waiting time for routine and urgent treatment, but one-third did not have such standards for detoxification services. Patient surveys and complaint analysis were common methods to monitor wait time. Conclusions: Findings indicate plans use a range of techniques to manage care, but prior authorization, a long-standing technique, was seldom required for outpatient SUD care. Understanding utilization management is of particular interest in the wake of federal parity legislation that curtails the use of more stringent management for behavioral health than is imposed for other medical care. Financial support: NIDA (R01 DA029316) and NIAAA (R01 AA010869). http://dx.doi.org/10.1016/j.drugalcdep.2014.09.477 Gender differences in smoking and treatment outcome among opioid-maintained smokers Andrew C. Meyer, Mollie E. Patrick, Sarah H. Heil, Stephen T. Higgins, Stacey C. Sigmon University of Vermont, Burlington, VT, United States Aims: Prior studies have suggested that gender differences may exist in the general population of smokers, with males often presenting with greater nicotine dependence yet showing better treatment response than females. Less is known about possible gender differences in hard-core subgroups of smokers, such as substance abusers. The present secondary analysis examined
e39
this question in opioid-maintained smokers receiving a behavioral intervention to promote smoking abstinence. Methods: Opioid-maintained smokers received a brief intervention aimed at establishing initial smoking abstinence and included daily visits, biochemical verification of smoking status via breath carbon monoxide and urinary cotinine, and financial incentives contingent upon abstinence. Participants were dichotomized based on gender, and differences in intake characteristics and treatment outcomes were analyzed. Results: Participants (52 males, 68 females) were 33 yrs old and had 12 yrs education. Males smoked more cigarettes per day (20 vs. 17 cigs/day; p = .03), had higher urinary cotinine levels (1537 vs. 1240 ng/ml; p = .01) and scored higher on the Fagerstrom Test for Nicotine Dependence (5.7 vs. 4.8; p = .02) than females, respectively. Males also showed less intention to smoke on the Questionnaire on Smoking Urges (35.3 vs. 45.1; p = .003). With regard to treatment response, males achieved significantly greater smoking abstinence, submitting 61% smoking-negative samples vs. 54% in females (p = .004). In addition to these primary outcomes, we will also examine gender differences in nicotine withdrawal and craving for inclusion in this June 2014 presentation. Conclusions: Consistent with prior studies in the general smoker population, opioid-maintained males exhibited greater nicotine dependence yet responded better to an intervention offering abstinence-contingent financial incentives. These data suggest that gender differences may also exist in substance abusers and extend these findings to opioid-dependent smokers receiving an empirically supported behavioral intervention. Financial support: R01 DA019550, T32 DA007242. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.478 Longitudinal gender differences in HIV and criminal justice outcomes Jaimie P. Meyer, J. Cepeda, F.L. Altice Yale, New Haven, CT, United States Aims: Inform gender-specific HIV interventions among criminal justice (CJ) populations by evaluating gender differences in HIV and CJ outcomes. Methods: Longitudinal CJ, pharmacy, and laboratory databases were linked in a retrospective cohort of HIV+ prisoners on ART. Gender differences were quantified by type of criminal offenses, incarceration periods, and HIV treatment outcomes. Logistic regression models identified correlates of viral suppression (VS; HIV-1 RNA < 400) among women with p < 0.05 being statistically significant (*). Results: Among 1089 HIV+ prisoners on ART, compared to 866 men (1620 incarceration periods), the 223 women (461 incarceration periods) were more likely to be younger (mean 40.2 vs 43.3 years*), white (30.9% vs. 17.2%*), have medical insurance (51.6% vs 9.1%*), have shorter incarceration periods (mean 181.0 vs 327.2 days*) and commit more non-violent misdemeanors (58.0% vs 46.0%*) and public order offenses (44.1% vs 32.1%*). During incarceration periods, women were more likely than men to receive antidepressants (69.1% vs 41.3%*), medication-assisted therapy for opioid dependence (17.5% vs 10.4%*) and achieve VS before release (80.0% vs 68.7%*). Upon CJ entry, one-third of women had VS, correlating with older age (aOR 1.08, 95% CI 1.02–1.14), receiving treatment for other comorbidities, and prescribed single fixed-dose ART combinations (aOR 2.28, 95% CI 1.02–5.13). Conclusions: In the largest contemporary cohort of HIV+ prisoners on ART, women’s incarceration and HIV treatment outcomes