A study to validate a self-reported version of the ONS drug dependence questionnaire

Economic evaluation: a comparison of methadone versus buprenorphine for opiate substitution treatment

BACKGROUND

The cost of opiate substitution is usually considered lower in cost when methadone is used, as compared to that of buprenorphine, however the overall cost effectiveness of substitution programmes comparing the two drugs remains largely unknown.

METHODS

We evaluated the treatment cost and effectiveness of methadone and buprenorphine when used in an opiate substitution programme in Norfolk, UK. All programme costs, estimated from the perspective of the drug treatment clinic, were collected on 361 opiate-dependent participants over a six-month period. Total costs comprised medication (methadone or buprenorphine) costs, pharmacy supervision and dispensing costs, and drug service clinic costs. Effectiveness was measured in terms of (1) each programmes ability to retain participants in the programme for six months, and (2) the ability of the programme to accomplish complete abstinence from illicit opiate consumption.

RESULTS

Overall, mean medication-only costs of methadone were lower than that of buprenorphine, however, pharmacy and clinic costs were lower for the buprenorphine programme. The covariate-adjusted mean total cost of the two programmes was not significantly different. Mean six-month retention rates were higher on the methadone programme, therefore, the methadone programme "dominates" the buprenorphine programme as it was slightly more effective for the same cost. Conversely, when ability to stop taking illicit opiates concomitant with opiate substitution medication was considered, the buprenorphine programme was more effective with an additional cost of £903 per individual who stopped illicit opiate use.

CONCLUSIONS

The provision of buprenorphine should be considered an appropriate treatment if cessation of illicit opiate use, concomitant with programme retention is considered an important outcome.

Drug use disorder (DUD) questionnaire: scale development and validation

BACKGROUND

Despite the ample interest in the measurement of substance abuse and dependence, obtaining biological samples from participants as a means to validate a scale is considered time and cost intensive and is, subsequently, largely overlooked.

OBJECTIVES

To report the psychometric properties of the drug use disorder (DUD) questionnaire including oral fluid and blood sample screening indicators measuring the three most commonly used illicit substances--marijuana, cocaine, and extramedicinal painkillers.

SUBJECTS

Participants were a subset (N = 2,702) of the 2007 U.S. National Roadside Survey that was administered to daytime and nighttime weekend drivers in the 48 contiguous states to examine the prevalence of substance use and misuse.

MEASURES

Participants completed demographic and substance use questions as well as the DUD--a 12-item measure assessing substance abuse and dependence. Participants could potentially have completed the DUD three times for each of the three substances. Subscales of abuse and dependence were created using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition Text Revision [DSM-IV-TR]) criteria of these diagnoses.

RESULTS

The DUD displayed adequate internal consistency on both subscales of substance abuse and dependence (Cronbach's α ranging from .71 to .84 and .83 to .92, respectively). The DUD also demonstrated construct validity in comparison to biological markers of each substance.

CONCLUSIONS

The DUD is a biologically validated instrument that is both easy to utilize and may have valuable implications as a research tool among both clinical and nonclinical populations.