While evidence-based treatments for opioid dependence are available, only 15 percent of affected individuals receive treatment. The availability of buprenorphine, an opioid dependence treatment approved by the FDA in 2002 with similar efficacy to methadone, was expected to lead to increased treatment rates. Although treatment rates have increased somewhat, they remain alarmingly low, leaving the majority of affected individuals at risk for adverse consequences including financial hardship, under-employment, transmission of hepatitis C and HIV, impaired driving, and crime. Restrictive insurance benefits for substance abuse may partially explain low treatment rates among the 53 percent of opioid dependent individuals with private insurance.
The aim of the newly-enacted federal substance abuse parity law is to equalize private coverage for behavioral and physical illnesses. This law, which will be implemented in January 2010, has the potential to substantially affect treatment patterns for opioid dependence. However, other access-related factors are also likely to be relevant. Almost no research has focused specifically on barriers to treatment among the privately insured, and these individuals may have different financial constraints, time costs, and attitudes towards treatment compared with uninsured or publicly insured opioid dependent individuals. We propose two specific aims: (1) to study the effects of federal substance abuse parity on use of opioid dependence treatment financed by private insurance and (2) to estimate the relative importance of attributes of opioid dependence treatment on privately insured individuals'decision to enter treatment. First, we will compare treatment utilization by individuals newly covered by federal substance abuse parity regulations beginning in 2010 with treatment utilization by individuals already covered under pre-existing state substance abuse parity laws. We will adapt current substance abuse identification, treatment initiation, and treatment engagement measures to compare treatment patterns for these two groups before and after federal parity implementation. Second, we will conduct an analysis of demand for treatment by eliciting opioid dependent individuals'preferences for price and non-price related treatment attributes. We will conduct qualitative interviews to identify treatment attributes that affect the decision to enter treatment. Next, we will field a web-based survey of treatment-seeking and non-treatment-seeking opioid dependent individuals with private insurance to elicit information on the relative value of different treatment attributes and to estimate how improvements in treatment options will affect treatment rates. Both the IOM Report Improving the Quality of Health Care for Mental Health and Substance- Use Conditions and NIDA's 2004 Blue Ribbon Task Force on Health Services Research identified a pressing need to improve receipt of effective services in real world settings. To transform care for opioid dependence, it is vital to identify the effects of both benefit expansion and attributes of treatment on utilization rates.

Public Health Relevance

Opioid dependence is a major public health concern in the United States, with economic costs estimated at $21 billion per year. While evidence-based treatments for opioid dependence are available, only 15 percent of affected individuals receive treatment. With the goal of increasing treatment rates, this project aims to evaluate the effects of federal parity on rates of use for opioid dependence treatment and to estimate how improving treatment options will affect rates of use among the 53 percent of opioid dependent individuals with private insurance.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Duffy, Sarah Q
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Yale University
Public Health & Prev Medicine
Schools of Medicine
New Haven
United States
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