Injection drug users (IDU) constitute an increasing proportion of new cases of AIDS and HIV infection. Yet little research has been conducted on the utilization of health services by active injection drug users. In the proposed project, 500 IDUs in Providence, Rhode Island will be interviewed regarding their health service use in the past six months and these self-reports will then be validated by abstraction of inpatient, outpatient and emergency room records at three hospitals in Providence. The study sample will include 250 active IDUs and 250 former injection drug users who have been in methadone maintenance for at least six months prior to enrollment. This retrospective cohort design takes advantage of the geographic compactness of Rhode Island, a single Needle Exchange program for recruitment of active drug users, limited out-migration of IDUs, the small number of health care facilities in our state and investigators at each of these facilities who have previously worked collaboratively on epidemiologic studies.
Specific Aim 1 is to provide estimates of health service utilization (emergency room, inpatient, outpatient) among different groups of IDUs--with or without HIV infection, in drug treatment and active users. We will test the following hypotheses: IDUs in drug treatment will have lower utilization of expensive health services (ER, hospitalization) than active IDUs; cocaine users will have higher rates of emergency room use and hospitalization than IDUs who do not use cocaine both in the active IDU cohort and the methadone cohort due to more frequent drug use and injection.
Specific Aim 2 is to provide estimates of total costs for IDUs in and out of treatment and test the hypothesis that the total cost for health care for IDUs will be lower among those receiving methadone maintenance. The medico-economic consequences of injection drug use will be important for Medicaid, and for Health Maintenance Organizations that are assuming Medicaid contracts and that currently have little data on which to base their benefit and program design decisions for this population

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
3R01DA010567-02S1
Application #
2793351
Study Section
Human Development Research Subcommittee (NIDA)
Project Start
1997-05-01
Project End
2000-04-30
Budget Start
1998-05-01
Budget End
2000-04-30
Support Year
2
Fiscal Year
1998
Total Cost
Indirect Cost
Name
Rhode Island Hospital (Providence, RI)
Department
Type
DUNS #
161202122
City
Providence
State
RI
Country
United States
Zip Code
02903
Rosengard, Cynthia; Anderson, Bradley; Stein, Michael D (2004) Intravenous drug users' HIV-risk behaviors with primary/other partners. Am J Drug Alcohol Abuse 30:225-36
Manheimer, Eric; Anderson, Bradley J; Stein, Michael D (2003) Use and assessment of complementary and alternative therapies by intravenous drug users. Am J Drug Alcohol Abuse 29:401-13
McGarry, Kelly A; Stein, Michael D; Clarke, Jennifer G et al. (2002) Utilization of preventive health services by HIV-seronegative injection drug users. J Addict Dis 21:93-102
Stein, Michael D; Friedmann, Peter (2002) Need for medical and psychosocial services among injection drug users: a comparative study of needle exchange and methadone maintenance. Am J Addict 11:262-70
Stein, M D; Maksad, J; Clarke, J (2001) Hepatitis C disease among injection drug users: knowledge, perceived risk and willingness to receive treatment. Drug Alcohol Depend 61:211-5
Bluthenthal, R N; Gogineni, A; Longshore, D et al. (2001) Factors associated with readiness to change drug use among needle-exchange users. Drug Alcohol Depend 62:225-30
Clarke, J G; Stein, M D; McGarry, K A et al. (2001) Interest in smoking cessation among injection drug users. Am J Addict 10:159-66
Gogineni, A; Stein, M D; Friedmann, P D (2001) Social relationships and intravenous drug use among methadone maintenance patients. Drug Alcohol Depend 64:47-53
Brienza, R S; Stein, M D; Chen, M et al. (2000) Depression among needle exchange program and methadone maintenance clients. J Subst Abuse Treat 18:331-7
Stein, M D; Urdaneta, M E; Clarke, J et al. (2000) Use of antiretroviral therapies by HIV-infected persons receiving methadone maintenance. J Addict Dis 19:85-94

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