Stigma and Prejudice: The Experience of Crack Users

Objective

To evaluate the stigma and prejudice experienced by crack users in their social context.

Method

A qualitative study developed through the Fourth Generation Evaluation, conducted with four interest groups (ten users, eleven families, eight employees, and seven managers), components of the mental health care network. For data collection, we used observation and individual interview. The analysis was performed through the constant comparative method.

Results

Crack users suffer prejudice and are stigmatized as those who do not fit in the systems established by society (without family links, formal employment and dwelling), and are thus excluded. They exhibit undisciplined behavior and, therefore, are discriminated, marginalized and considered as criminals, losing their uniqueness and living in vulnerable situations.

Conclusion

The evaluation process emphasized the need to demystify the social imaginary that demonizes the chemically dependent, being thus important to develop public policies with actions focused on health, prevention, information and combat to stigma...

The capitalist society establishes the licit and illicit consumption of goods and products. In relation to crack, the user frequently consumes it in public spaces, occupying these places. Most people believes in the social imaginary that these people must be removed from the street, in order to "clean" these spaces - an urban cleaning(P1).

Therefore, it is necessary to construct a society that does not moralize life situations or the problems faced by citizens, because these factors influence the right of using public spaces that belong to everyone.

Concerning the issue of crack and drug addiction, before moving, preventing access and hiding, society must demystify the idea that the user is someone incapable, dangerous and without conditions. We need to disseminate information and deal with this problem as a health issue. We also must include the economic, educational and social assistance sector, in addition to policies, proposing the right to health care, access to public spaces and, especially, to support healthcare institutions that are prepared to assist this kind of user. To deal with drugs we need to combat prejudice and stigma and, thereby, health assistance is oriented by the production of social life.

It is possible to affirm that prejudice and stigma are very similar social processes that can result in discrimination, involving categorization and labeling, stereotyping and social rejection⁽ 12 ⁾...

Full article at:   http://goo.gl/TSJBs7

By:  Nathália Duarte Bard, 1 Beatriz Antunes, 2 Cristine Moraes Roos, 3 Agnes Olschowsky, 4 and Leandro Barbosa de Pinho5

¹Undergraduate student in Nursing, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. Scholarship holder from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil

²Master's student, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

³PhD

⁴PhD, Full Professor, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

⁵PhD, Adjunct Professor, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

Corresponding Author: Nathália Duarte Bard Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manuel, 963 Bairro: Rio Branco CEP: 90620-110, Porto Alegre, RS

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Outcomes for Physicians with Opioid Dependence Treated without Agonist Pharmacotherapy in Physician Health Programs

Highlights

• Participants in physician health programs were grouped based on their substance(s) of abuse.
• Opioid users had similar treatment outcomes as alcohol only and non-opioid drug users.
• Abstinence-based PHP care management produces long-term abstinence.AIMS:

To compare treatment outcome among substance dependent physicians enrolled in a physician health program (PHP) who have a history of alcohol use only, any opioid use, or non-opioid drug use, in order to determine whether the distinctive PHP system of care management is as effective for individuals with opioid use disorders as for those with alcohol or other drug use disorders.

METHODS:

A 5-year, retrospective chart review, intent-to-treat analysis was conducted for all physicians admitted to 16 physician health programs (N=702; 85.5% male; age range=24-75). Analyses compared treatment outcomes for participants based upon their substance(s) of abuse [i.e., 1) "Alcohol Only" (n=204), 2) "Any Opioid" with or without alcohol use (n=339), and 3) "Non-Opioid" drug use with or without alcohol use (n=159)].

RESULTS:

In this sample, 75-80% of physicians across the three groups never tested positive for alcohol or drugs during their extended care management period with random drug testing. This included physicians with opioid dependence who did not receive opioid substitution therapy (OST). Of the 22.1% of physicians who had a positive test, two thirds (i.e., 14.5% of the total sample) had just one positive test, and only one third (i.e., 7.6% of the total sample) had more than one positive test. These results were similar in all three groups.

CONCLUSIONS:

These results indicate that individuals with opioid use disorders who are managed by PHPs can achieve long-term abstinence from opioids, alcohol, and other drugs without OST through participation in abstinence-based psychosocial treatment with extended, intensive care management following discharge.

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By:  Merlo LJ1, Campbell MD2, Skipper GE3, Shea CL4, DuPont RL5.

• 1University of Florida, Department of Psychiatry, 4001 SW 13th St, Gainesville, FL 32608. Electronic address: lmerlo@UFL.edu.
• 2Institute for Behavior and Health, Inc., 6191 Executive Blvd, Rockville, MD 20852 USA. Electronic address: Campbell.Mike@jeassociates.com.
• 3Promises Treatment Centers, 2515 Wilshire Blvd, Santa Monica, CA 90403. Electronic address: gregory.skipper@gmail.com.
• 4Institute for Behavior and Health, Inc., 6191 Executive Blvd, Rockville, MD 20852 USA. Electronic address: corinne.shea@ibhinc.org.
• 5Institute for Behavior and Health, Inc., 6191 Executive Blvd, Rockville, MD 20852 USA. Electronic address: BobDuPont@aol.com.
• J Subst Abuse Treat. 2016 May;64:47-54. doi: 10.1016/j.jsat.2016.02.004. Epub 2016 Feb 13.

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The Relationship Between Non-Medical Use of Prescription Opioids and Sex Work Among Adults in Residential Substance Use Treatment

Highlights

• Sex work (SW) is common among patients in residential substance use treatment.
• SW among individuals in addictions treatment is associated with more extensive substance use and greater psychiatric severity.
• Non-medical use of prescription opioids is widespread among individuals involved in SW.

High rates of substance use (e.g., alcohol, cocaine, heroin) have been documented among individuals who engage in sex work (SW), and adults seeking substance use disorder (SUD) treatment frequently report prior engagement in SW. Non-medical use of prescription opioids (NMUPO) has increased over the last decade, but little is known about the relationship between NMUPO with sex exchange. 

The purpose of this study was to describe the prevalence of recent SW among patients at a large residential SUD treatment center and examine the association between NMUPO and SW. Approximately 14% of 588 adults reported involvement in SW in the month prior to treatment. NMUPO was more common among those with a history of SW (95% of sex workers vs. 74% of non-sex-workers), and this association remained statistically significant after controlling for demographic factors, other substance use and psychiatric symptom severity (odds ratio=3.38). SW is relatively common among patients in residential SUD treatment, and is associated with greater psychiatric severity and more extensive substance use, including alarming rates of NMUPO. 

Addiction treatment for individuals involved in SW may benefit from the addition of content related to NMUPO.

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By:  Matusiewicz AK1, Ilgen MA2, Bonar EE3, Price A3, Bohnert AS2.

• VA Center for Clinical Management Research (CCMR), 2800 Plymouth Rd. Building 16, Ann Arbor MI 48109 USA; Department of Psychiatry, University of Michigan, 2800 Plymouth Rd. Building 16, Ann Arbor MI 48109 USA; VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor MI 48109 USA. Electronic address: amatusie@uvm.edu.
• 2VA Center for Clinical Management Research (CCMR), 2800 Plymouth Rd. Building 16, Ann Arbor MI 48109 USA; Department of Psychiatry, University of Michigan, 2800 Plymouth Rd. Building 16, Ann Arbor MI 48109 USA.
• 3Department of Psychiatry, University of Michigan, 2800 Plymouth Rd. Building 16, Ann Arbor MI 48109 USA. 
• J Subst Abuse Treat. 2016 May;64:24-8. doi: 10.1016/j.jsat.2016.01.010. Epub 2016 Feb 13.

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Examining the Role of Substance Abuse in Elder Mistreatment: Results from Mistreatment Investigations

Substance abuse has long been identified as a risk factor for elder mistreatment, yet research on the topic remains sparse. 

This study tested hypotheses whether perpetrator and victim substance use problems were associated with financial exploitation, physical abuse, emotional abuse, and neglect versus no abuse. Cross-sectional data were collected on 948 cases with yes/no substantiation decisions where 357 cases had no abuse in elder mistreatment investigations. Hypotheses were tested using odds ratios, bivariate, and multiple linear regression analyses including a control for victim vulnerability. 

Of 948 alleged victims, 42 (4.4%) exhibited signs of substance use problems. Among the 323 alleged perpetrators, 87 (26.9%) were reported to have substance use problems. Substance use problems by alleged perpetrators were associated (p< .01) with financial exploitation, physical abuse, and emotional abuse but not neglect. Substance use problems by alleged victims were associated with neglect, but not the other types. Alleged perpetrators with substance use problems tended to commit multiple forms of abuse, were male and not caregivers. Except for the findings on neglect, the associations with elder mistreatment were stronger for alleged perpetrators with substance use problems, than for alleged victims. 

Clarification of the role of perpetrator risk factors such as substance abuse should improve risk identification and subsequent intervention.

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By:  Conrad KJ1, Liu PJ2, Iris M3.

• 1University of Illinois at Chicago, IL, USA Chestnut Health Systems, Normal, IL, USA kjconrad@uic.edu.
• 2University of California, San Francisco, CA, USA.
• 3Leonard Schanfield Research Institute, Chicago, IL, USA. 

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Impulsivity, Sensation Seeking, and Risk-Taking Behaviors among HIV-Positive and HIV-Negative Heroin Dependent Persons

Objective.

The aim of this study was to compare impulsivity and risky decision making among HIV-positive and negative heroin dependent persons.

Methods.

We compared different dimensions of impulsivity and risky decision making in two groups of 60 HIV-positive and 60 HIV-negative male heroin dependent persons. Each group was comprised of equal numbers of current (treatment seeker) and former (abstinent) heroin addicts. Data collection tools included Balloon Analogue Risk Task (BART), Iowa Gambling Task (IGT), Barratt Impulsiveness Scale (BIS), and Zuckerman Sensation Seeking Scale (SSS).

Results.

In SSS, comprised of four subscales including thrill and adventure seeking (TAS), experience seeking (ES), disinhibition (DIS), and boredom susceptibility (BS), there was a borderline difference in DIS (P = 0.08) as HIV-positive group scored higher than HIV-negative group. Also, ES and total score were significantly higher among HIV-positive patients. In BART, HIV-positive subjects scored higher in risk taking than HIV-negative subjects as reflected in higher Average Number of puffs in Successful Balloons (ANSB). In BIS, HIV-positive group scored significantly higher in cognitive impulsivity (CI) (P = 0.03) and nonplanning impulsivity (NPI) (P = 0.05) in comparison to HIV-negative group. Also, current heroin addicts scored significantly higher in NPI compared to former addict HIV-negative participants (P = 0.015). IGT did not show any significant difference between groups.

Conclusion.

Higher levels of impulsivity and risk taking behaviors among HIV-positive heroin addicts will increase serious concerns regarding HIV transmission from this group to other opiate dependents and healthy people.

Comparison of subscale scores in each test between HIV-positive group and HIV-negative group.

Item∗	HIV-positive group	HIV-negative group	P value♦
Zuckerman Sensation Seeking Scale (SSS)
Thrill and adventure seeking	6.70 ± 2.80	6.33 ± 2.55	0.45
Experience seeking	4.28 ± 1.90	3.30 ± 2.03	0.007
Disinhibition	3.52 ± 1.65	2.95 ± 1.89	0.083
Boredom susceptibility	2.70 ± 1.65	2.48 ± 1.44	0.44
SSS total score	17.20 ± 5.75	15.07 ± 5.13	0.03
Balloon Analogue Risk Task (BART)
Average Number of puffs in Successful Balloons	34.58 ± 17.11	25.15 ± 13.35	0.002
Number of Successful Balloons	17.52 ± 4.02	22.63 ± 4.00	<0.001
Average Number of puffs in Each Balloon	30.40 ± 12.40	23.64 ± 11.58	0.004
Barratt Impulsiveness Scale (BIS)
Nonplanning impulsivity	28.38 ± 4.10	26.75 ± 4.99	0.053
Motor impulsivity	24.43 ± 5.04	24.57 ± 6.51	0.9
Cognitive impulsivity	19.47 ± 4.27	17.67 ± 4.94	0.035
BIS total score	72.25 ± 10.67	69.08 ± 14.02	0.16
Iowa Gambling Task (IGT)
Total duration of IGT (seconds)	286.54 ± 168.38	314.54 ± 144.77	0.38
Net amount of win (win − loss)	−12667.50  ±  −11223.32	−14242.93 ± 14446.33	0.55
IGT total score [(C + D)−(A + B)]	−2.56 ± 21.54	−5.65 ± 29.38	0.55

∗Data are represented as mean ± SD.

♦Independent sample t-test.

Full article at:   http://goo.gl/SKfpj0

By:  Koosha Paydary, ^{1 , 2 , 3} Somayeh Mahin Torabi, ² SeyedAhmad SeyedAlinaghi, ¹ Mehri Noori, ² Alireza Noroozi, ^{4 , 5}Sara Ameri, ^{1 , 2 , 3} and Hamed Ekhtiari ^{2 , 6 , *}

¹Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences (TUMS), Tehran, Iran

²Neurocognitive Laboratory, Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran

³Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran

⁴School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences (TUMS), Tehran, Iran

⁵Head of Substance Abuse Prevention and Treatment Office (SAPTO), Mental Health, Social Health and Addiction Department (MeHSHAD), Ministry of Health and Medical Education (MoHME), Tehran, Iran

⁶Translational Neuroscience Program, Institute for Cognitive Science Studies (ICSS), Tehran University of Medical Sciences (TUMS), Tehran, Iran

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Buprenorphine Treatment for Hospitalized, Opioid-Dependent Patients

IMPORTANCE

Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency among persons seeking addiction treatment. However, effectiveness for out-of-treatment, hospitalized patients is not known.

OBJECTIVE

To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT, increase sustained engagement in OAT, and decrease illicit opioid use at 6 months after hospitalization.

DESIGN, SETTING, AND PARTICIPANTS

From August 1, 2009, through October 31, 2012, a total of 663 hospitalized, opioid-dependent patients in a general medical hospital were identified. Of these, 369 did not meet eligibility criteria. A total of 145 eligible patients consented to participation in the randomized clinical trial. Of these, 139 completed the baseline interview and were assigned to the detoxification (n = 67) or linkage (n = 72) group.

INTERVENTIONS

Five-day buprenorphine detoxification protocol or buprenorphine induction, intrahospital dose stabilization, and postdischarge transition to maintenance buprenorphine OAT affiliated with the hospital’s primary care clinic (linkage).

MAIN OUTCOMES AND MEASURES

Entry and sustained engagement with buprenorphine OAT at 1, 3, and 6 months (medical record verified) and prior 30-day use of illicit opioids (self-report).

RESULTS

During follow-up, linkage participants were more likely to enter buprenorphine OAT than those in the detoxification group (52 [72.2%] vs 8 [11.9%], P < .001). At 6 months, 12 linkage participants (16.7%) and 2 detoxification participants (3.0%) were receiving buprenorphine OAT (P = .007). Compared with those in the detoxification group, participants randomized to the linkage group reported less illicit opioid use in the 30 days before the 6-month interview (incidence rate ratio, 0.60; 95% CI, 0.46-0.73; P < .01) in an intent-to-treat analysis.

CONCLUSIONS AND RELEVANCE

Compared with an inpatient detoxification protocol, initiation of and linkage to buprenorphine treatment is an effective means for engaging medically hospitalized patients who are not seeking addiction treatment and reduces illicit opioid use 6 months after hospitalization. However, maintaining engagement in treatment remains a challenge.

LEVEL OF EVIDENCE:

Level 3 Prognostic.

Below:  Distribution of Rates of Illicit Opioid Use During Follow-up Assessment by Intervention in 116 Individuals. 

A, Detoxification group; B, linkage group. To facilitate description, rates were calculated as days of illicit opioid use per 30 follow-up days using all available data, including the mean of all assessments for each study participant with multiple follow-up data or any follow-up time point for participants with one time point.

Full article at:   http://goo.gl/zwTQgS

By:  Jane M. Liebschutz, MD, MPH, Denise Crooks, MPH, Debra Herman, PhD, Bradley Anderson, PhD, Judith Tsui, MD, MPH, Lidia Z. Meshesha, BA, Shernaz Dossabhoy, BA, and Michael Stein, MD

Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts (Liebschutz, Crooks, Tsui, Dossabhoy); Department of Medicine, Boston University School of Medicine, Boston, Massachusetts (Liebschutz, Tsui); Department of General Internal Medicine, Butler Hospital, Providence, Rhode Island (Herman, Anderson, Stein); Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island (Herman, Anderson, Stein); Department of Psychology, The University of Memphis, Memphis, Tennessee (Meshesha).

Corresponding Author: Jane M. Liebschutz, MD, MPH, Boston Medical Center, 801 Massachusetts Ave, Second Floor, Boston, MA 02118 

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Gendered Contexts: Psychopathy and Drug Use in Relation to Sex Work and Exchange

Few scholars have examined psychopathology correlates of sex work. It has been suggested that sex work may reflect manifestations of impulsive-antisocial psychopathic traits (e.g., reckless disregard, delinquency) in women more than men. 

The current work examined relative contributions of drug dependence and distinct psychopathic features in relation to traditional forms of sex work (i.e., prostitution) in women, along with gender differences in psychopathy relationships with casual forms of sex exchange (i.e., trading sex for necessities). 

Study 1 included 171 community-dwelling women offenders, and Study 2 included 319 participants (42.3% women) with histories of drug use and/or violence. Participants completed the Psychopathy Checklist: Screening Version, prostitution was measured as self-report and/or public record data across studies, and sex exchange in Study 2 was assessed using a questionnaire based on prior research on sexual risk-taking. 

Findings across both studies demonstrated that although psychopathic traits, particularly impulsive-antisocial features, were associated with prostitution in women above the use of drugs, drug dependence did not moderate the relationship between psychopathic traits and prostitution in women. 

Analyses of Study 2 data revealed that impulsive-antisocial traits were associated with sex exchange at low, but not high, levels of interpersonal-affective traits across participants. As well, interpersonal-affective traits were significantly positively related to sex exchange in men and not significantly (and negatively) related in women. 

In sum, impulsive-antisocial traits related to prostitution among women, suggesting that women may manifest these traits within intimate contexts. Moreover, findings indicated gender differences in the manifestation of interpersonal-affective traits within sexual exchange contexts.

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By:  Edwards BG, Verona E. [Vitae]

Department of Psychology, University of South Florida

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Normalising Desistance: Contextualising Marijuana & Cocaine Use Careers in Young Adults

Although there is a vast literature on drug use and addiction, there is little work that addresses the long-term use of drugs within the general population. 

We take a more contextual look in examining longitudinal drug use patterns over the course of 14 years for a representative sample of young adults in their late teens and early twenties in the United States using the National Longitudinal Survey of Youth (NLSY). We use a growth trajectory modelling approach for cocaine and marijuana users to determine general use careers. 

Using contextual and life-course variables, we then estimate a multinomial logistic regression model to predict group membership. In addition to establishing general use career groups, we ask how well mainstream theories comport with our findings and how the different chemical makeup of cocaine and marijuana influence our findings. 

We find four general use career groups: 

1. high use/late desistance; 
2. peaked use/strong desistance; 
3. low use; and 
4. stable use/gradual desistance. 

Our results suggest similar careers for users of both drugs, with desistance over time as the rule for all groups. We also find some support for life-course and contextual factors in drug using patterns, but our findings challenge other psychological and criminological theories.

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By:  Roussell A1, Omori M2.

• 1Department of Criminal Justice & Criminology, Washington State University, Pullman, USA.
• 2Department of Sociology, University of Miami, USA.
• Sociol Health Illn. 2016 Apr 1. doi: 10.1111/1467-9566.12421. 

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Improvements in Health-Related Quality of Life among Methadone Maintenance Clients in Dar Es Salaam, Tanzania

BACKGROUND:

Injection of heroin has become widespread in Dar es Salaam, Tanzania and is spreading throughout the country. To prevent potential bridging of HIV epidemics, the Tanzanian government established a methadone maintenance treatment (MMT) clinic in February 2011. We assess the effect of MMT on health-related quality of life (HRQOL) and examine factors, particularly HIV infection and methadone dose, associated with changes in HRQOL.

METHODS:

This study utilized routine data on clients enrolling in methadone from February 2011 to April 2012 at Muhimbili National Hospital. Change in physical (PCS) and mental health (MCS) composite scores, as measured by the SF-12 tool, were the primary outcomes. Backward stepwise linear regression, with a criterion of p<0.2 was used to identify baseline exposure variables for inclusion in multivariable models, while adjusting for baseline scores.

RESULTS:

A total of 288 MMT clients received baseline and follow-up assessments. Mean methadone dose administered was 45mg (SD±25) and 76 (27%) were confirmed HIV-positive. Significant improvements were observed in PCS and MCS, with mean increases of 15.7 and 3.3, respectively. In multivariable models, clients who had previous poly-substance use with cocaine [p=0.040] had a significantly higher mean change in PCS. Clients who were living with HIV [p=0.002]; satisfied with current marital situation [p=0.045]; had a history of suicidal thoughts [p=0.021]; and previously experienced cognitive difficulties [p=0.012] had significantly lower mean change in PCS. Clients with shorter history of heroin use [p=0.012] and who received higher methadone doses [p=0.028] had significantly higher mean change in MCS, compared to their counterparts.

CONCLUSION:

Aspects of mental and physical health, risk behaviors and quality of life among drug users are intertwined and complex. Our research revealed positive short-term effects of MMT on HRQOL and highlights the importance of sustained retention for optimal benefits. Comprehensive supportive services in addition to provision of methadone are needed to address the complex health needs of people who inject drugs.

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By:  Ubuguyu O1, Tran OC2, Bruce RD3, Masao F1, Nyandindi C1, Sabuni N4, McCurdy S5, Mbwambo J1, Lambdin BH6.

• 1Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania.
• 2Pangaea Global AIDS, 436 14th St, Suite 920, Oakland, CA 94612, USA.
• 3Yale University, New Haven, CT 06520, USA.
• 4Tanzania Ministry of Health and Social Welfare, 6 Samora Machel Ave, Dar es Salaam, Tanzania.
• 5University of Texas School of Public Health, 7000 Fannin St, Houston, TX, USA.
• 6RTI-International, 351 California St, Suite 500, San Francisco, CA 94104, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. Electronic address: blambdin@rti.org. 
• Int J Drug Policy. 2016 Mar 11. pii: S0955-3959(16)30065-2. doi: 10.1016/j.drugpo.2016.03.005

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An Economic Evaluation of Contingency Management for Completion of Hepatitis B Vaccination in Those on Treatment for Opiate Dependence

AIMS:

To determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost-effective use of healthcare resources.

DESIGN:

A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and healthcare cost impact of the vaccination strategies, followed by a Markov process to evaluate the long-term clinical consequences and costs associated with hepatitis B infection.

SETTINGS AND PARTICIPANTS:

Data on attendance to vaccination from a UK cluster randomised trial.

INTERVENTION:

Two contingency management options were examined in the trial: fixed vs. escalating schedule financial incentives.

MEASUREMENT:

Lifetime healthcare costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios.

FINDINGS:

The resulting estimate for the incremental lifetime healthcare cost of the contingency management strategy versus usual care was £22 (95% CI: -£12 to £40) per person offered the incentive. For 1,000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI: 8 to 30). The probabilistic incremental cost per quality adjusted life year gained of the contingency management programme was estimated to be £6,738 (95% CI: £6,297 to £7,172), with an 89% probability of being considered cost-effective at a threshold of £20,000 per quality-adjusted life years gained (98% at £30,000).

CONCLUSIONS:

Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost-effective use of healthcare resources in the UK as long as the incidence remains above 1.2%.

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By:  Rafia R1, Dodd PJ1, Brennan A1, Meier PS2, Hope VD3, Ncube F3, Byford S4, Tie H4, Metrebian N5, Hellier J6, Weaver T7, Strang J5.

• 1Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield.
• 2Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield.
• 3Injecting Drug Use Team, HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE).
• 4Centre for the Economics of Mental and Physical Health, King's College London.
• 5National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London.
• 6Department of Biostatistics, King's College London.
• 7Department of Mental Health, Social work and Integrative Medicine, Middlesex University. 
• Addiction. 2016 Mar 18. doi: 10.1111/add.13385. 

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