Table 3.
State Transitions* Estimated from the First Episode of Each of the Five States, with Selected Associated Factors
| Model 1a: All Causec | Model 2b: Subdistribution Models to Account for Risks of Transitioning to Each of the 4 Other Statesc | |||||
|---|---|---|---|---|---|---|
| Time to discontinuation for episodes of | HR (95% CI) | HR (95% CI) | HR (95% CI) | HR (95% CI) | HR (95% CI) | HR (95% CI) |
| Opioid agonist treatment | Model 1A | Model 2A | ||||
| OAT->Death | OAT->OOT | OAT->Detox | OAT->SUP | OAT->INC | ||
| Primary PO user (vs heroin) | 0.85 (0.82, 0.88) | 0.91 (0.62, 1.34) | 0.88 (0.85, 0.91) | 0.63 (0.44, 0.89) | 0.81 (0.66, 0.98) | 0.67 (0.51, 0.88) |
| Secondary drug (vs none): Heroin/PO | 0.96 (0.91, 1.01) | 0.64 (0.34, 1.21) | 0.95 (0.90, 0.99) | 0.96 (0.61, 1.51) | 1.25 (0.98, 1.60) | 0.91 (0.62, 1.33) |
| Alcohol/marijuana | 1.14 (1.08, 1.20) | 1.28 (0.77, 2.14) | 1.12 (1.06, 1.19) | 1.16 (0.72, 1.88) | 1.03 (0.76, 1.40) | 1.08 (0.74, 1.56) |
| Stimulants | 1.15 (1.10, 1.20) | 0.86 (0.52, 1.44) | 1.10 (1.05, 1.15) | 0.94 (0.61, 1.45) | 1.44 (1.14, 1.83) | 1.73 (1.31, 2.27) |
| Detoxification | Model 1B | Model 2B | ||||
| Detox->Death | Detox->OOT | Detox->OAT | Detox->SUP | Detox->INC | ||
| Primary PO user (vs heroin) | 0.93 (0.90, 0.97) | 0.76 (0.23, 2.51) | 0.78 (0.75, 0.80) | 1.65 (1.54, 1.77) | 0.91 (0.64, 1.30) | 0.40 (0.23, 0.70) |
| Secondary drug (vs none): Heroin/PO | 1.00 (0.96, 1.04) | 2.33 (0.64, 8.58) | 0.86 (0.82, 0.90) | 1.34 (1.23, 1.45) | 1.06 (0.66, 1.69) | 1.25 (0.69, 2.28) |
| Alcohol/marijuana | 1.08 (1.03, 1.14) | 0.90 (0.11, 7.08) | 1.10 (1.04, 1.16) | 0.83 (0.73, 0.94) | 1.14 (0.65, 1.99) | 1.04 (0.51, 2.13) |
| Stimulants | 1.08 (1.03, 1.12) | 1.77 (0.42, 7.54) | 1.03 (0.98, 1.08) | 1.00 (0.9, 1.11) | 1.72 (1.12, 2.64) | 1.17 (0.66, 2.08) |
| Out of treatment | Model 1C | Model 2C | ||||
| OOT->Death | OOT->OAT | OOT->Detox | OOT->SUP | OOT->INC | ||
| Primary PO user (vs heroin) | 0.75 (0.72, 0.78) | 1.07 (0.88, 1.30) | 0.90 (0.85, 0.96) | 0.75 (0.70, 0.81) | 0.79 (0.67, 0.92) | 0.71 (0.66, 0.77) |
| Secondary drug (vs none): Heroin/PO | 0.94 (0.89, 0.99) | 1.28 (0.99, 1.64) | 0.94 (0.86, 1.03) | 0.87 (0.79, 0.96) | 1.16 (0.93, 1.43) | 0.96 (0.86, 1.07) |
| Alcohol/marijuana | 0.97 (0.91, 1.02) | 1.04 (0.78, 1.39) | 0.84 (0.76, 0.93) | 0.96 (0.87, 1.07) | 1.23 (0.99, 1.55) | 1.17 (1.05, 1.30) |
| Stimulants | 1.06 (1.01, 1.11) | 1.09 (0.85, 1.39) | 0.84 (0.77, 0.91) | 0.93 (0.85, 1.02) | 1.46 (1.21, 1.77) | 1.50 (1.38, 1.64) |
| Legal supervision | Model 1D | Model 2D | ||||
| SUP->Death | SUP->OOT | SUP->OAT | SUP->Detox | SUP->INC | ||
| Primary PO user (vs heroin) | 0.83 (0.77, 0.90) | 0.56 (0.27, 1.15) | 1.37 (1.22, 1.53) | 0.74 (0.6, 0.92) | 0.47 (0.36, 0.62) | 0.86 (0.76, 0.97) |
| Secondary drug (vs none): Heroin/PO | 0.98 (0.88, 1.08) | 0.98 (0.40, 2.43) | 0.98 (0.84, 1.15) | 0.94 (0.72, 1.23) | 0.80 (0.57, 1.12) | 1.02 (0.87, 1.19) |
| Alcohol/marijuana | 0.92 (0.84, 1.02) | 1.34 (0.66, 2.71) | 1.12 (0.97, 1.30) | 0.74 (0.55, 1.00) | 1.01 (0.74, 1.37) | 0.95 (0.82, 1.11) |
| Stimulants | 1.06 (0.98, 1.14) | 0.95 (0.50, 1.79) | 0.94 (0.83, 1.08) | 1.09 (0.89, 1.33) | 0.98 (0.76, 1.25) | 1.11 (0.99, 1.25) |
| Incarceration | Model 1E | Model 2E | ||||
| INC->Death | INC->OOT | INC->OAT | INC->Detox | INC->SUP | ||
| Primary PO user (vs heroin) | 1.30 (1.21, 1.39) | 1.01 (0.16, 6.26) | 1.18 (0.95, 1.46) | 0.96 (0.51, 1.81) | 1.01 (0.38, 2.64) | 1.17 (1.08, 1.27) |
| Secondary drug (vs none): Heroin/PO | 1.07 (0.97, 1.18) | – | 1.01 (0.76, 1.35) | 1.07 (0.50, 2.30) | 0.92 (0.26, 3.29) | 1.05 (0.94, 1.16) |
| Alcohol/marijuana | 1.08 (0.99, 1.19) | 1.40 (0.22, 8.88) | 1.24 (0.94, 1.63) | 1.01 (0.44, 2.34) | 1.38 (0.35, 5.37) | 1.00 (0.91, 1.11) |
| Stimulants | 1.02 (0.95, 1.10) | – | 0.94 (0.73, 1.20) | 0.84 (0.43, 1.64) | 1.36 (0.50, 3.71) | 1.03 (0.96, 1.11) |
Bolded values are statistically significant at α=0.05. CI, confidence interval; detox, detoxification treatment; HR, hazard ratio; INC, incarceration; OOT, out of treatment; SUP, legal supervision.
a
Model 1: all-cause Cox proportional hazards.
b
Model 2: proportional subdistribution hazards.
c
Covariates included but not displayed above: gender, age at first treatment admission, race/ethnicity, and binary indicators reflecting whether the previous episode was either a detoxification or opioid agonist treatment (OAT) episode, or whether the previous episode lasted 365 days or more.