ArticleMedical decision making : an international journal of the Society for Medical Decision Making2017
Estimating State Transitions for Opioid Use Disorders.
Article in Medical decision making : an international journal of the Society for Medical Decision Making, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Economic Evaluation in Opioid Modeling: Systematic Review.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2021Pooled it
- Adults with problematic opioid use released from jail: Mutual help groups and medication support contribute to a greater likelihood of opioid abstinence.Drug and alcohol dependence · 2026Article
- Article
- Modeling Health and Economic Outcomes of Providing Stable Housing to Homeless Adults With OUD.JAMA network open · 2025Article
- Longitudinal trends in nonmedical prescription opioid use in a cohort of rural Appalachian people who use drugs.Preventive medicine · 2020Article
- Opioid agonist treatment and fatal overdose risk in a state-wide US population receiving opioid use disorder services.Addiction (Abingdon, England) · 2020Article
- Short-Term Effects and Long-Term Cost-Effectiveness of Universal Hepatitis C Testing in Prenatal Care.Obstetrics and gynecology · 2019Article
- The costs of crime during and after publicly funded treatment for opioid use disorders: a population-level study for the state of California.Addiction (Abingdon, England) · 2017Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
aimThe aim was to estimate transitions between periods in and out of treatment, incarceration, and legal supervision, for prescription opioid (PO) and heroin users.
methodsWe 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.
resultsBoth 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 < 0.001), white (74.6% v. 63.1%; P < 0.001), and had completed high school (31.8% v. 18.9%; P < 0.001). When compared to primary heroin users, PO users had a higher hazard of transitioning from detoxification to OAT (Hazard Ratio (HR), 1.65; 95% CI, 1.54 to 1.77), and had a lower hazard of transitioning from out-of-treatment to either detoxification (0.75 [0.70, 0.81]) or OAT (0.90 [0.85, 0.96]).
conclusionOur findings can be applied directly in state transition modeling to improve the validity of health economic evaluations. Although PO users tended to remain in treatment for longer durations than heroin users, they also tended to remain out of treatment for longer after transitioning to an out-of-treatment state. Despite the proven effectiveness of time-unlimited treatment, individuals with OUD spend most of their time out of treatment.
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