Journal of Neurology and Psychology

Editorial

Investment in Treatment of Psychological Disorders Could Save Money

Ayman Fareed*

  • Department of Psychiatry, Emory University School of Medicine, USA

*Address for Correspondence: Ayman Fareed, MD, Assistant Professor, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA, Tel: (404) 321-6111 X 7104; E-mail: ayman.fareed@va.gov
 
Citation: Fareed A. Investment in Treatment of Psychological Disorders Could Save Money. J Neurol Psychol. 2013;1(1): 2.
 
Copyright © 2013 Fareed A. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
 
Journal of Neurology and Psychology | ISSN: 2332-3469 | Volume: 1, Issue: 1
 
Submission: 07 June 2013 | Accepted: 10 June 2013 | Published: 14 June 2013

In this editorial we will explain how investment in treatment of psychological disorders could save overall cost. We will give the example of a common psychological disorder which is addiction. Addiction to prescription opioids became a new epidemic in the United States. The Drug Abuse Warning Network (DAWN) reported that the number of Emergency Department (ED) visits related to nonmedical use of prescribed opioid significantly increased (111%) between 2004 and 2008 [1]. The highest numbers of visits were recorded for oxycodone, hydrocodone and methadone [2]. Buprenorphine is a relatively new medication which has been approved for treatment of opioid dependence in October 2002. It became available in the market in 2003. Buprenorphine has many qualities that make it an effective treatment for opioid dependence. It is a partial mu receptor agonist that can hinder priming for opioids and is safer compared with other full opioid receptor agonists [1]. It has kappa receptor antagonistic properties that may improve dysphoric mood in this population [2]. Buprenorphine is a promising and practical option for managing opioid addiction in patients receiving long-term opioid maintenance treatment, particularly for those who may not qualify for or desire methadone maintenance treatment. A meta-analysis was recently published [3] about the effect of buprenorphine dose on treatment outcome. It was concluded that the higher buprenorphine dose predicted better retention in treatment compared with the lower buprenorphine dose, and the positive urine drug screens for opioids predicted dropping out of treatment. Retention in treatment predicted less illicit opioid use, and the positive urine drug screens for cocaine predicted more illicit opioid use. There is strong evidence based on 21 randomized clinical trials that the higher buprenorphine dose may improve retention in buprenorphine maintenance treatment and reduce the risk of relapse. Based on this study a cost based analysis was presented at the Global Addiction conference May, 2013 in Pisa, Italy. The presenters showed that the buprenorphine dose range 16-24 mg daily had a significantly better retention compared to 0-8 mg, 8-16 mg or 24-32 mg daily. The cost analysis showed that each $1 invested to provide a dose range 16-24 mg daily is expected to save $4 in return to the society than would be saved by spending $1 to provide a lower dose range e.g. 8-16 mg daily. It was concluded that the societal benefits among buprenorphine patients dosed at 16-24 mg daily may justify treatment providers to pay the extra ingredients costs to dose patients within this dose range when clinically and financially appropriate to do so.
Some studies report that non-fatal illicit drug overdose significantly predicted subsequent drug overdose [4-6]. Therefore prevention of future opioid overdose in high risk patients may reduce mortality and morbidity in this population. Several studies reported that Methadone Maintenance Treatment (MMT) can reduce the risk of overdose andmortality in this population [7-11]. Brugal et al. [12] recently reported that the life expectancy of their cohort of heroin users in MMT increased by 21 years during the period of the study. Factors contributing to increased life expectancy included a reduced incidence of Acquired Immune Deficiency Syndrome (AIDS) and reduction of death related to drug overdose. Caplehorn et al. [13] performed a meta-analysis to study the relationship between being in MMT and the risk of drug related mortality. They found that MMT reduces the risk of overall mortality in this population by 25%, primarily due to reduction of the risk of accidental overdose (heroin in particular). Conversely, dropping out of MMT increases the risk of drug overdose and mortality. Langendam et al. [14] reported that in their cohort of drug users, participation in harm-reduction MMT reduced the risk of overdose death, whereas leaving treatment was associated with increased risk.A new interest in using a sustained release naltrexone implant as prophylaxis against heroin overdose has gained some popularity in Australia [15-17]. Hulse et al. [16] found a lower rate of hospitalization for accidental overdose in patients receiving the implant treatment. Ngo et al. [17] reported that naltrexone implants have long-term benefits in reducing opioid related hospital morbidity.At the present time we have several evidence based options for treatment of opioid dependence that could save many lives and reduce the negative impact of the untreated disease on the society. Treatment of addictive disorders has been a neglected area of medicine. Lack of treatment can lead to devastating effects to the society. The increased rate of violence, suicide and frequent utilization of emergency rooms could increase the overall cost if preventive measures and early treatment would not be provided to this population.

References

  1. Cowan A (2007) Buprenorphine: the basic pharmacology revisited. J Addict Med 1: 68-72.
  2. Gerra G, Fantoma A, Zaimovic A (2006) Naltrexone and buprenorphine combination in the treatment of opioid dependence. J Psychopharmacol 20: 806-814.
  3. Fareed A, Vayalapalli S, Casarella J, Drexler K (2012) Effect of buprenorphine dose on treatment outcome. J Addict Dis 31: 8-18.
  4. Kerr T, Fairbairn N, Tyndall M, Marsh D, Li K, et al. (2007) Predictors of non-fatal overdose among a cohort of polysubstance-using injection drug users. Drug Alcohol Depend 87: 39-45.
  5. Darke S, Williamson A, Ross J, Mills KL, Havard A, et al. (2007) Patterns of nonfatal heroin overdose over a 3-year period: findings from the Australian treatment outcome study. J Urban Health 84: 283-291.
  6. van Beek I, Dakin A, Kimber J, Gilmour S (2004) The Sydney medically supervised injecting centre: reducing harm associated with heroin overdose. Critical Public Health 14: 391-406.
  7. Gunne LM, Gronbladh L (1981) The Swedish methadone maintenance program: a controlled study. Drug Alcohol Depend 7: 249-256.
  8. Gronbladh L, Ohlund LS, Gunne LM (1990) Mortality in heroin addiction: impact of methadone treatment. Acta Psychiatr Scand 82: 223-227.
  9. Gearing FR, Schweitzer MD (1974) An epidemiologic evaluation of long-term methadone maintenance treatment for heroin addiction. Am J Epidemiol 100: 101-112.
  10. Cushman P Jr (1977) Ten years of methadone maintenance treatment: some clinical observations. Am J Drug Alcohol Abuse 4: 543-553.
  11. Poser W, Koc J, Ehrenreich H (1995) Methadone maintenance treatment. Methadone treatment can reduce mortality. BMJ 310: 463.
  12. Brugal MT, Barrio G, De LF, Regidor E, Royuela L, et al. (2002) Factors associated with non-fatal heroin overdose: assessing the effect of frequency and route of heroin administration. Addiction 97: 319-327.
  13. Caplehorn JR, Dalton MS, Haldar F, Petrenas AM, Nisbet JG (1996) Methadone maintenance and addicts’ risk of fatal heroin overdose. Subst Use Misuse 31: 177-196.
  14. Langendam MW, van Brussel GH, Coutinho RA, van Ameijden EJ (2001) The impact of harm-reduction-based methadone treatment on mortality among heroin users. Am J Public Health 91: 774-780.
  15. Tait RJ, Ngo HT, Hulse GK (2008) Mortality in heroin users 3 years after naltrexone implant or methadone maintenance treatment. J Subst Abuse Treat 35: 116-124.
  16. Hulse GK, Tait RJ, Comer SD, Sullivan MA, Jacobs IG, et al. (2005) Reducing hospital presentations for opioid overdose in patients treated with sustained release naltrexone implants. Drug Alcohol Depend 79: 351-357.
  17. Ngo HT, Tait RJ, Hulse GK (2008) Comparing drug-related hospital morbidity following heroin dependence treatment with methadone maintenance or naltrexone implantation. Arch Gen Psychiatry 65: 457-465.