Abstract

To date, over $154 million has been granted to over 256 organizations and programs to address mental health and substance misuse, with 71% of the funds used to reduce substance misuse. Several programs funded by Caring for Denver directly address the needs of Denver’s population experiencing housing instability and SUD. Grants are given to programs that specifically utilize peer support to address community needs, including housing, employment, necessities, crisis intervention, and recovery support. These initiatives aim to bridge the gap between MOUD treatment, peer support services, and the population with SUD in Denver. However, while these programs employ evidence-based strategies, their effectiveness and impact are yet to be fully understood. To provide insight into the potential impact of Caring for Denver grants for peer support service programs coupled with MOUD, we propose to conduct a series of analyses utilizing the Reducing Infections Related to Drug Use Cost Effectiveness (ReDUCE) model to estimate the 5-year and 10-year impact of Caring for Denver programs on healthcare utilization and health outcomes.

We will use the REDUCE Model, a validated Monte Carlo microsimulation model that simulates the natural history of injection opioid use, to compare the long-term effectiveness of two approaches to improving health among Denverites experiencing homelessness with substance use disorders: 1) standard services without Caring for Denver funded programs (status quo); 2) addition of peer support service programs and medications for opioid use disorder (MOUD) (Caring for Denver).

In both strategies, individuals will have probabilities of infections and overdose, hospitalization with hospital-based services (either methadone or buprenorphine), and access to community-based providers that have the ability to provide MOUD. In the status quo strategy, individuals receive standard outpatient linkage to care probabilities that are based on nationally representative data. In the Caring for Denver strategy, individuals have different linkage and retention probabilities based on programmatic data. In this regard, the Caring for Denver strategy models a synergistic approach to care with increased capacity of community providers.

The simulated population is a cohort of Denverites who predominately inject illicit opioids such as fentanyl and heroin and are unhoused. The cohort will be informed by local, publicly available data as well as programmatic data. We will employ the simulation to estimate outcomes for the cohort including: 1) mortality and hospitalizations attributable to overdose, endocarditis and SSTI over the time horizon, 2) life expectancy. Our time horizon will be 5- and 10-years. We will calculate the outcomes averted over these time horizons resulting from Caring for Denver funding.

We will perform both deterministic and probabilistic sensitivity analyses. We will perform deterministic sensitivity analyses on key parameters to understand the factors that drive effectiveness. Additionally, because there is uncertainty regarding the empiric data that will be used to inform the population and impact of Caring for Denver funded programs on model parameters, we will perform probabilistic sensitivity analyses (PSA) to generate quantitative estimates of uncertainty in selected simulated outcomes. For each PSA, we will perform1,000 simulations on a cohort of 1,000 people.

We anticipate that our findings will provide a comprehensive and longitudinal portrait of the impact of Caring for Denver funded programs that provide peer services and MOUD for people who are unhoused in Denver. These findings are important as they will demonstrate the unmeasured outcomes of these programs as well as the importance of this fiscal investment. 

Recognizing the need to combat substance misuse, Denver voters, through a ballot initiative, approved a 0.25% sales tax increase to fund mental health and substance use programs. The Caring for Denver Foundation (C4D) was established to support Denver’s population with substance misuse through community-informed solutions. To date, over $154 million has been granted to over 256 organizations and programs to address mental health and substance misuse, with 71% of the funds used to reduce substance misuse.

Funding

Caring for Denver Foundation: 202404-02994

Publications

Coming soon.