the university of georgia the treatment of oxycodone abuse: organizational predictors of admissions...

The University of Georgia

The Treatment of Oxycodone Abuse:Organizational Predictors of

Admissions

Hannah K. KnudsenLori J. DucharmeJ. Aaron JohnsonPaul M. Roman

The University of Georgiahttp://www.uga.edu/ntcs

The authors acknowledge the support of the National Institute on Drug Abuse (R01DA14482 & R01DA13110)

http://www.uga.edu/ntcs


Trends in Non-Medical Use of Controlled Release (CR) Oxycodone

• Several data sources suggest that non-medical use of CR-oxycodone is increasing– Increased use in National Household Survey on Drug Use &

Health between 2002 - 2003– Increased use among adolescents between 2002 - 2004 in

Monitoring the Future data– More frequent mentions in DAWN emergency room data

• Some researchers have begun to consider the characteristics of individuals who seek treatment for CR-oxycodone abuse/dependence

• There is virtually no national data on the characteristics of treatment organizations that are serving these clients


Treatment-Seeking for Oxycodone Abuse: The Relevance of Organizations

• Understanding the types of individuals who seek treatment is only part of the health services question

• It is critical to consider the characteristics of settings from which clients seek treatment for oxycodone abuse

• We examine four domains in predicting the admission of clients for oxycodone abuse/dependence:– Geographical variables– Treatment center type– Organizational/structural characteristics– Service delivery characteristics


Research Questions

• To what extent are oxycodone admissions a function of regional and rural/urban differences?

• Are certain types of centers—based on ownership, funding, and profit status—more likely to be treating oxycodone-dependent clients?

• Are there associations between structural characteristics and oxycodone admissions?

• Are admissions associated with service delivery characteristics (levels of care, availability of medications, 12-step programming)?


Methods: Panel Longitudinal Data

• Publicly-funded centers (N = 362)– National random sample – Centers receive > 50% funding from government block

grants/contracts• Privately-funded centers (N = 401)

– National random sample– Centers receive < 50% funding from government block

grants/contracts• Sources of data

– Independent variables via baseline face-to-face interviews Public center response rate = 80% Private center response rate = 87%

– Dependent variables via telephone follow-up interviews conducted 6 months after baseline

Response rate = 86.9% (N = 666) – Respondents are center administrators/clinical directors


Methods: Variables & Analysis• Dependent Variable 1: Any Oxycodone Admissions in Past Six

Months– 1 = yes, 0 = no– Logistic regression analysis

• Dependent Variable 2: Number of Oxycodone Admissions in Past Six Months– Count data– Negative binomial regression analysis

• Independent Variables– Geographical Measures: Region, Location in rural county– Center Type: Government-owned, publicly funded non-profit

(reference), privately funded non-profit, for-profit– Other Center Characteristics: Center size in FTEs, Center age,

Accreditation (JCAHO, CARF), Location in hospital– Service Delivery: Levels of care (inpatient-only, inpatient &

outpatient, outpatient-only), Offers buprenorphine, Offers naltrexone, Offers methadone, Requires 12-step meeting attendance during treatment

– Controls for year of baseline interview


Descriptive Statistics: Independent Variables

Region Levels of Care Offers Buprenorphine

9.21%

Northeast 21.78% Inpatient-Only 17.76%

Midwest 27.30% IP & Outpatient 39.03% Offers Naltrexone 30.32%

South 27.97% Outpatient-Only 43.22% Offers Methadone 15.75%

West 22.95% Center Size (FTEs) Requires 12-Step Attendance during Treatment

65.15%

Center Type 1-10 FTEs 33.50%

Government 14.07% 11-30 FTEs 36.68%

Public Non-Profit 34.51% > 30 FTEs 29.82% Rural County 11.22%

Private Non-Profit 35.85% JCAHO Accredited 36.85% Interviewed in 2002 47.91%

For-Profit 15.58% CARF Accredited 13.56% Interviewed in 2003 42.38%

Mean Center Age 23.95 years Hospital-Based 25.80% Interviewed in 2004 9.72%


Oxycodone Admissions in the Past Six Months

69.0%

31.0%

0%

20%

40%

60%

80%

AnyAdmissions

No Admissions

Any Admissions

No Admissions

• The majority of centers reported at least one admission in the prior six months

• The average number of admissions over the previous six-month period was 17.3 admissions (SD = 51.48)


Logistic Regression (N = 597):Any Oxycodone Admissions in Past Six Months

Odds Ratio Odds Ratio Odds Ratio


3.424+

Northeast NS Inpatient-Only NS

Midwest .598+ IP & Outpatient NS Offers Naltrexone 2.621**

South Ref. Outpatient-Only Ref. Offers Methadone 1.768+

West .421** Center Size (FTEs) Requires 12-Step Attendance during Treatment

1.735**

Center Type 1-10 FTEs Ref.

Government 2.375** 11-30 FTEs 1.700*

Public Non-Profit Ref. > 30 FTEs 1.570+ Rural County NS

Private Non-Profit 2.747*** JCAHO Accredited NS Interviewed in 2002 Ref.

For-Profit 3.230*** CARF Accredited NS Interviewed in 2003 NS

Center Age .990+ Hospital-Based NS Interviewed in 2004 NS

+p<.10, *p<.05, **p<.01, ***p<.001 (two-tailed)


Negative Binomial Regression (N = 509):Number of Oxycodone Admissions

% Change in Expected Count % Change in Expected Count % Change in Expected Count


194.1%**

Northeast NS Inpatient-Only NS

Midwest NS IP & Outpatient NS Offers Naltrexone NS

South Ref. Outpatient-Only Ref. Offers Methadone 158.1%***

West NS Center Size (FTEs) Requires 12-Step Attendance during Treatment

71.6%**

Center Type 1-10 FTEs Ref.

Government 100.1%* 11-30 FTEs 106.6%**

Public Non-Profit Ref. > 30 FTEs 155.2%** Rural County 82.8%*

Private Non-Profit 77.1%* JCAHO Accredited 102.8%* Interviewed in 2002 Ref.

For-Profit 102.9%* CARF Accredited NS Interviewed in 2003 NS

Center Age NS Hospital-Based NS Interviewed in 2004 NS

*p<.05, **p<.01, ***p<.001 (two-tailed)


Key Findings

• Geographical Variables– While location in a rural county did not predict “any

admissions,” centers in rural counties reported a significantly greater number of admissions

– Region was only significant in the “any admissions” model

• Center Type– Oxycodone admissions were significantly related

to treatment sector– Both for-profit & privately funded non-profits had

greater oxycodone admissions than publicly funded non-profits


Key Findings (Continued)

• Organizational/structural characteristics– Center size mattered– JCAHO accreditation was positively associated

with the number of admissions

• Service Delivery– Admissions are somewhat a function of the

availability of pharmacotherapy for opiate addiction

– Requiring 12-step meeting attendance was also positively associated with admissions

the university of georgia the treatment of oxycodone abuse: organizational predictors of admissions...

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