1. The University of Georgia The Treatment of Oxycodone Abuse: Organizational Predictors of Admissions Hannah K. Knudsen Lori J. Ducharme J. Aaron Johnson Paul M. Roman The University of Georgia http://www.uga.edu/ntcs The authors acknowledge the support of the National Institute on Drug Abuse (R01DA14482 & R01DA13110)

2. The University of Georgia 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

3. The University of Georgia 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

4. The University of Georgia 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)?

5. The University of Georgia 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

6. The University of Georgia 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

7. The University of Georgia Descriptive Statistics: Independent Variables RegionLevels of CareOffers Buprenorphine 9.21% Northeast21.78%Inpatient-Only17.76% Midwest27.30%IP & Outpatient39.03%Offers Naltrexone30.32% South27.97%Outpatient-Only43.22%Offers Methadone15.75% West22.95%Center Size (FTEs)Requires 12-Step Attendance during Treatment 65.15% Center Type1-10 FTEs33.50% Government14.07%11-30 FTEs36.68% Public Non-Profit34.51%> 30 FTEs29.82%Rural County11.22% Private Non-Profit35.85%JCAHO Accredited36.85%Interviewed in 200247.91% For-Profit15.58%CARF Accredited13.56%Interviewed in 200342.38% Mean Center Age23.95 yearsHospital-Based25.80%Interviewed in 20049.72%

8. The University of Georgia Oxycodone Admissions in the Past Six Months 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)

9. The University of Georgia Logistic Regression (N = 597): Any Oxycodone Admissions in Past Six Months Odds Ratio RegionLevels of CareOffers Buprenorphine 3.424 + NortheastNSInpatient-OnlyNS Midwest.598 + IP & OutpatientNSOffers Naltrexone2.621** SouthRef.Outpatient-OnlyRef.Offers Methadone1.768 + West.421**Center Size (FTEs)Requires 12-Step Attendance during Treatment 1.735** Center Type1-10 FTEsRef. Government2.375**11-30 FTEs1.700* Public Non-ProfitRef.> 30 FTEs1.570 + Rural CountyNS Private Non-Profit2.747***JCAHO AccreditedNSInterviewed in 2002Ref. For-Profit3.230***CARF AccreditedNSInterviewed in 2003NS Center Age.990 + Hospital-BasedNSInterviewed in 2004NS +p<.10, *p<.05, **p<.01, ***p<.001 (two-tailed)

10. The University of Georgia Negative Binomial Regression (N = 509): Number of Oxycodone Admissions % Change in Expected Count RegionLevels of CareOffers Buprenorphine 194.1%** NortheastNSInpatient-OnlyNS MidwestNSIP & OutpatientNSOffers NaltrexoneNS SouthRef.Outpatient-OnlyRef.Offers Methadone158.1%*** WestNSCenter Size (FTEs)Requires 12-Step Attendance during Treatment 71.6%** Center Type1-10 FTEsRef. Government100.1%*11-30 FTEs106.6%** Public Non-ProfitRef.> 30 FTEs155.2%**Rural County82.8%* Private Non-Profit77.1%*JCAHO Accredited102.8%*Interviewed in 2002Ref. For-Profit102.9%*CARF AccreditedNSInterviewed in 2003NS Center AgeNSHospital-BasedNSInterviewed in 2004NS *p<.05, **p<.01, ***p<.001 (two-tailed)

11. The University of Georgia 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

12. The University of Georgia 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