Publication Type: Abstract
Abstract: Rationale: In response to state budget shortfalls in 2003, the Oregon Health Plan made several changes to its benefit package offered to the enrollees who were not part of the “Categorically Eligible” Medicaid population. One important change was the elimination of coverage for outpatient substance abuse treatment, including methadone treatment for heroin addiction. As other states consider cuts in their coverage of substance abuse treatment, the Oregon experience can provide evidence about the expected impact on costs and utilization.

Objectives: The objective of this paper is to compare the effect of an elimination of the substance abuse benefit on methadone users’ utilization of medical services and expenditures for those services.

Methodology: We use data on claims from members of the Oregon Health Plan who were subject to the cuts in their benefit package. We selected individuals who were enrolled in the plan for at least six months before and after the 2003 benefit changes. 381 methadone users and 15,713 non-users were identified through the claims data. Following Hirano, Imbens, and Ridder, we used matching with an estimated propensity score to evaluate the difference-in-differences in outcomes between methadone users and non-users. We estimated the change in office visits to physicians, emergency department visits, and hospital admissions, and expenditures for these services.

Results: After the elimination of substance abuse treatment benefits, visits and expenditures for physician services and emergency services showed significant increases after the substance abuse benefit was eliminated. Inpatient admissions increased, but at a rate that was less than the control group.

Conclusions: Our results suggest that the elimination of outpatient substance abuse benefits increased expenses associated with emergency departments and office visits. Elimination of substance abuse programs may not be a effective method of reducing expenditures for Medicaid programs.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: Most prisoners with histories of heroin addiction become re-addicted within one month of release. Re-addiction to heroin among this population is associated with devastating public safety and public health consequences. Therefore, effective drug abuse treatment that begins in the institution and continues in the community is urgently needed. Over 35 years of research evidence has found that methadone maintenance treatment is effective in reducing heroin use and its related criminal activity. However, such an intervention has not been rigorously examined for prisoners in the United States. This study is the first to involve initiation of methadone maintenance of pre-release prison inmates with pre-incarceration histories of heroin addiction. Male pre-release inmates with heroin dependence in the year before incarceration, no adjudicated charges or pending parole hearings, and 3-6 months to serve before release were randomly assigned to one of three treatment conditions: 1) counseling only; 2) counseling, with opportunity to initiate methadone maintenance treatment upon release; and 3) counseling, with initiation of methadone maintenance treatment in prison, with opportunity to continue such treatment upon release. Outcomes on the first 100 participants at 6-months post-release include: treatment entry and retention; heroin use; cocaine use; criminal activity; HIV risk behavior; and employment. Results are expected to have important implications for treatment planning and correctional policy.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: This analysis will examine how and why methadone maintenance became a prominent item on the American national agenda in the late 1960s, only to be substantially discarded in less than a decade. The "political career" of methadone maintenance was propelled by the public acts of a "constellation of social groups in conflict" (Gusfield, 1986) over the symbolism of this "new" form of treatment. In its rise to prominence, methadone was presented by the Nixon Administration as a wonder drug that was going to solve the extremely complex problems of street crime and other urban problems, in addition to heroin dependence. As methadone maintenance became politicized, representing different things to different groups, it was also reviled, exposing America's historical ambivalence toward drug addiction and methods of treatment.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: A substantial percentage of incarcerated individuals in the United States have pre-incarceration histories of heroin addiction. These individuals seldom receive substance abuse treatment during incarceration or upon release, and typically resume heroin addiction and criminal activity within one month of release. Methadone maintenance treatment, found effective in community settings, has rarely been implemented and evaluated in correctional settings in the United States. This unique study, involving male pre-release prison inmates in Baltimore, Maryland, compares the relative effectiveness of three treatment conditions: 1) counseling only in prison; 2) counseling in prison, with transfer to community-based methadone maintenance upon release; and 3) counseling and methadone maintenance in prison, with continuation of methadone maintenance in the community upon release. Outcomes at 12-month post-release are presented with regard to heroin use, cocaine use, and criminal activity, and both self-report and urine drug screening are used to assess drug use. The policy implications of the results are discussed.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: This paper provides baseline characteristics and three month-post release follow-up outcomes of male inmates involved in a unique study examining the benefits of methadone maintenance treatment initiated in prison and continued in the community. Self-report data obtained at baseline examine lifetime patterns of criminal activity, substance abuse, and justice system involvement, and respondents are classified according to the most serious level of offense. Relationships between the severity of crime and respondent characteristics (demographics, substance use history, mental health, family and peer deviance) will be examined. In addition, three-month outcomes will be reported in terms of heroin and cocaine use (self report and urinalysis results), criminal activity(self report and incarceration), and treatment retention.