Decrease in Healthcare Utilization and Costs for Opioid Users Following Residential Integrated Treatment for Co- Occurring Disorders

Background: Opioid use results in higher healthcare utilization and costs, particularly among those with co-occurring mental health disorders. Presumably, effective treatment would result in a reduction in healthcare utilization and costs. To date, research has not examined this question. As such, the purpose of this study was to estimate and compare pre- and post-treatment healthcare utilization and costs for individuals receiving residential integrated treatment for co-occurring mental health and opioid use disorders.

Methods: A single-group, repeated measures design was used to examine changes in pre- and post-treatment healthcare utilization and costs among a sample of 1394 individuals with co-occurring mental health and opioid use disorders who received residential, integrated treatment at one of four facilities. Baseline data was obtained from face-to-face interviews at treatment entry. Telephone interviews at 30-days and 6-months post-discharge were used to collect follow-up data. Items from the Addiction Severity Index and the Treatment Services Review were utilized to measure healthcare utilization domains. At intake, patients reported the number of emergency room admissions in the previous six months for medical, mental health, and substance use problems, respectively. Patients also reported the number of nights they spent in the hospital for medical, mental health, and substance use problems, respectively. At the 30-day post-discharge interview, patients reported ER visits and hospital stays since leaving residential treatment. At the six-month post-discharge interview, patients reported ER visits and hospital stays since their last. Data from the 30-day and six-month interviews were summed within each category to obtain an estimate of ER visits and hospital stays in the six months following treatment, allowing a valid comparison window for the six-month pre-treatment estimates. Utilization costs were calculated based upon an average cost per ER admission and average cost per night for hospital stays.

Results: Statistically significant reductions in emergency rooms visits, inpatient stays, for medical, mental health, and substance use problem. Further, resulting costs were observed in the six months following treatment across all domains. The greatest impact was in the use of the ER and hospital overnight stays for substance use problems. This reduction in utilization translated to a savings over pretreatment costs of $1,217,607 in the six months following treatment for these services alone. Significant savings were also noted for mental health disorder services of nearly $747,857 across the two levels of care.  Medical savings were also significant at $956,556.  Total savings accrued across both levels of care for all three services were more than $2,922,020. Savings were recognized for the entire population of respondents, regardless of completion of treatment, relapse, relapse severity or the use of continuing care and aftercare services.

Conclusions: Residential, integrated treatment of co-occurring mental health and opioid use disorders can significantly decrease both utilization and cost of healthcare among opioid users with co-occurring mental health disorders. Attending treatment to address substance abuse and mental health issues can play a significant role in reducing the use of expensive acute care such as ER visits as well as reduce the number of overnight stays in hospitals.