12- MONTH OUTCOME OVERVIEW

1. New Jersey Medication Assisted Treatment Initiative (MATI): Twelve Month Outcomes Paterson (N=105; 19%) Received NE Services = 89% Percent Suboxone = 23.1% Newark (N=94; 16%) Received NE Services = 66% Percent Suboxone = 22.8% Trenton (N=75; 14%) Received NE Services = 4% Percent Suboxone = 31.5% Jude Iheoma, Ph.D. 1; Robert Culleton; Ph.D. 1; Suzanne Borys, Ed.D. 1; Charles Neighbors, Ph.D. 2; Sarah Dauber, Ph.D. 2 ; Gerod Hall Ph.D. 2; MerriBeth Adams, Ph.D. 4, Jon Morgenstern, Ph.D 2 3 1 Division of Mental Health and Addiction Services (DMHAS) of the State of New Jersey; 2 The National Center on Addiction and Substance Abuse (CASA) at Columbia University; 3 Department of Psychiatry, Columbia University Medical Center; 4 The National Council on Alcoholism and Drug Dependence: New Jersey. Plainfield (N=102; 19%) Received NE Services = 21% Percent Suboxone = 23.2% Atlantic City (N=84; 16%) Received NE Services = 44% Percent Suboxone = 48% Camden (N=84; 16%) Received NE Services = 70% Percent Suboxone = 35.1% Lynn Kovich, Assistant Commissioner INTRODUCTION DISCUSSION METHOD MATI Program Eligibility: (1) Household income at or below 350% of the Federal Poverty Level; (2) Resident of New Jersey; (3) History of injection drug use; (4) Test positive for opiates; (5) Proof of identification; (6) Not currently enrolled in Opioid Replacement Therapy; and (7) Uninsured. Evaluation Participants: Participants were N = 542individuals enrolled in opioid replacement treatment and counseling across the six MATI sites in New Jersey. See Figure 1 for site characteristics and Table 1 for demographic characteristics. Study Procedures:Program clients were offered the option to participate in the evaluation by their intake counselor or case manager upon treatment program entry. If interested and eligible, potential participants met with a research assistant located at either the office base clinic or stationed on the mobile medication unit. Eligibility criteria for the evaluation study included: ability to read in English at least at an 8th grade level, current enrollment in treatment, and provision of informed consent. Participants were rescheduled if they were intoxicated at the time of the interview. Clients agreed to be interviewed once every six months for 18 months, provide at least one collateral contact, and provide urine toxicology results for objective data verification. Each interview lasted approximately 90 minutes. Participants were informed that data from the evaluation was confidential and completely separate from their treatment. Measures: Addiction Severity Index (ASI; McLellan et al., 1992); the Treatment Services Review (McLellan, Alterman, Woody & Metzger, 1992); AIDS Risk Assessment Scale (Simpson et al., 1994); and a measure created by our team examining treatment access and barriers to care. Data Analysis:Study participants were stratified according to referral source (needle exchange or self-referral) or the opiate medication prescribed at baseline (methadone or suboxone) for purposes of comparing differences in baseline characteristics and outcomes at twelve months (see needle exchange vs. self-referral and Methadone vs. Suboxone tables). Of the 542 evaluation participants, 417 completed a 12-month follow-up interview and are included in the outcome analyses presented. BASELINE CHARATERISTICS • The MATI program is one of the first to implement a multi-method approach to engage and retain high risk IVDUs in opioid replacement treatment. The majority of individuals were referred from needle exchange programs highlighting that programs that structure inter-agency cooperation can produce successful referrals to care. • Most participants had extensive treatment histories and reported obstacles to obtaining treatment in the general categories of personal motivation, financial, difficulties and long waitlists. These reasons highlight that the goals of the program were well-suited to this population. Of those who had been to treatment in the past, >80% reported that it was easier to obtain treatment through the MATI program. • The 12-month follow-up data reveal how the strategies employed influenced positive outcomes. • How does providing treatment on demand to uninsured populations impact long-term outcomes? • At 12-month follow-up, MATI clients demonstrated reduced heroin use, decreased injection drug use and needle sharing, decreased illegal activity and days detained or incarcerated, and reductions in Emergency Room use. • These positive outcomes were associated with significant cost savings. • Were there baseline differences in client characteristics or differences in 12-month outcomes between needle exchange and self-referred clients? • At baseline, needle exchange clients were more likely to be male and have unstable housing, were less likely to have a chronic medical problem, and reported less heroin usecompared to self-referred clients. • At 12 months, no meaningful differences between the groups on substance use or illegal activity were found. • At 12 months, participants referred from needle exchange had higher rates of detention/incarceration and ER use compared to those self-referred. • Were there baseline differences in client characteristics or differences in 12-month outcomes between Methadone and Suboxone prescribed clients? • At baseline, Suboxone clients used cannabis more often, used needles less often, and were more likely to experience serious depression compared to Methadone clients. • At 12 months there were no meaningful differences between the groups on outcomes . • It is important to note that there were some participants in each group who switched medications between the baseline and 12-month interviews. • The same pattern of results was found when limited only to those participants who did not switch medications after baseline. • The Suboxone sample is just as or more severe than the Methadone sample, which is contrary to previous research that presents buprenorphine and Suboxone patients as more stable than their Methadone counterparts. • When taken together the results reveal that overall program goals of referring disenfranchised opioid dependent IVDUs to treatment directly from needle exchange, providing treatment on demand to uninsured populations, and offering a choice of opioid replacement therapies are largely being achieved. • Outcome data suggest that the MATI program is associated with positive outcomes for participants and significant savings in criminal justice costs and costs associated with emergency room use. The Bloodborne Disease Harm Reduction Act (P.L. 2006, c.99) was signed into law by Governor Jon Corzine on December 19, 2006. This law made New Jersey the 50th state in the nation to enact what is commonly called “Needle Exchange” policy. The law requires the Department of Health and Senior Services (DHSS) to establish a demonstration program that would permit up to six municipalities to operate a sterile syringe access program in accordance with the provisions of this act. In addition, the law appropriates $10,000,000 from the General Fund annually to the Department of Human Services (DHS), Division of Mental Health and Addiction Services (DMHAS), for inpatient and outpatient drug abuse treatment program slots and outreach. Underlying the impetus for funding is that novel systems re-engineering and intervention strategies are needed to combat the numerous obstacles to engaging and retaining high risk IV drug users in treatment. The Division of Mental Health and Addiction Services of the State of New Jersey (NJ-DMHAS) developed a pilot demonstration project entitled “The Medication Assisted Treatment Initiative” (MATI). This innovative project is designed to provide medication assisted treatment and supportive housing to the indigent, non-insured syringe exchange program population without access to treatment via mobile medication units and office based services. The program has been in progress for 41 months at six community and two supportive housing sites across New Jersey. A total of 3,225 clients, with a mean age of 42, of whom 36% were female, were served. 12- MONTH OUTCOME OVERVIEW SITE CHARACTERISTICS EVALUATION AIMS The National Center on Addiction and Substance Abuse (CASA) at Columbia University is evaluating this pilot program at all six demonstration and two supportive housing sites by conducting interviews with a sample of 542 mobile medication unit clients and 71 supportive housing clients over an 18 month period. Administrative records will also be used to examine differential outcomes between those enrolled in MATI and traditional Methadone programs using a matched sample design. This poster presentation will focus on 12 month recovery outcomes based on the opiate medication prescribed at baseline, as well as whether participants were referred from needle exchange or self-referred. NEEDLE EXCHANGE -vs- SELF-REFERRAL FIGURE 1: Participants were well-represented across sites. Four of six sites had associated needle exchange programs (4 colored boxes). When these programs were combined, over 65% of the individuals in treatment received services at the needle exchange, and 60% were directly referred to treatment from needle exchange. Approximately 30% of the sample (N=158) received Suboxone. All sites except Newark had a mobile unit. MOBILE UNIT METHADONE -vs- SUBOXONE CONTACT NJDMHAS: Jude Iheoma,: Jude.Iheoma@dhs.state.nj.us CASA: Charles Neighbors: cneighbors@casacolumbia.org NCADDNJ: MerriBeth Adams: madams@ncaddnj.org *Note that participants were assigned to medication groups based on the type of medication they were prescribed upon admission to the MATI program.