Racial and ethnic differences in opioid agonist treatment for opioid use disorder in a U.S. national sample

Noa Krawczyk, Kenneth A. Feder, Michael I Fingerhood, Brendan Saloner

Research output: Contribution to journalArticle

Abstract

Background Opioid Agonist Treatment (OAT) is the standard of care for the treatment of opioid use disorders. However, most people in treatment do not receive OAT. This study evaluated whether there are racial and/or ethnic differences in OAT receipt among adults entering specialty treatment for opioid use disorders in publicly-funded treatment programs across the U.S. Methods Using data from the national Treatment: Episode Data Base, odds of OAT receipt were compared among black, Hispanic and white clients. Mediation analyses were used to explore whether any racial/ethnic differences in OAT receipt were explained by variation in clinical need or by other treatment, sociodemographic, or geographic characteristics. Interaction terms were used to assess whether this association was modified by primary opioid type. Results Only 28.7% of clients received OAT. Odds of OAT receipt were significantly higher odds among blacks (OR: 2.27(2.14–2.41)) and Hispanics (OR: 1.98(1.88–2.09)), compared to whites. Differences in clinical need accounted for a substantial portion of this difference (76.79% and 49.74%, respectively). Differences persisted after accounting for other potential explanatory variables (adjusted OR: 1.37 (1.24–1.52); 1.21(1.11–1.32)), but were only evident for primary heroin users (adjusted OR: 1.50 (1.34–1.69); 1.29 (1.17–1.42)) and not other opioid users. Conclusions OAT receipt in treatment programs is low overall and particularly lacking among white heroin users. Differences in OAT receipt cannot be fully explained by differences in clinical need. More research is needed to understand and address barriers that underpin these differences so more patients with opioid use disorder can access evidenced-based treatment.

Original languageEnglish (US)
Pages (from-to)512-518
Number of pages7
JournalDrug and Alcohol Dependence
Volume178
DOIs
StatePublished - Sep 1 2017

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Opioid Analgesics
Therapeutics
Heroin
Hispanic Americans
Standard of Care

Keywords

  • Ethnic minorities
  • Medication assisted treatment
  • Opioid agonist treatment
  • Opioid treatment programs
  • Opioid use disorder
  • Racial disparities

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Racial and ethnic differences in opioid agonist treatment for opioid use disorder in a U.S. national sample. / Krawczyk, Noa; Feder, Kenneth A.; Fingerhood, Michael I; Saloner, Brendan.

In: Drug and Alcohol Dependence, Vol. 178, 01.09.2017, p. 512-518.

Research output: Contribution to journalArticle

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abstract = "Background Opioid Agonist Treatment (OAT) is the standard of care for the treatment of opioid use disorders. However, most people in treatment do not receive OAT. This study evaluated whether there are racial and/or ethnic differences in OAT receipt among adults entering specialty treatment for opioid use disorders in publicly-funded treatment programs across the U.S. Methods Using data from the national Treatment: Episode Data Base, odds of OAT receipt were compared among black, Hispanic and white clients. Mediation analyses were used to explore whether any racial/ethnic differences in OAT receipt were explained by variation in clinical need or by other treatment, sociodemographic, or geographic characteristics. Interaction terms were used to assess whether this association was modified by primary opioid type. Results Only 28.7{\%} of clients received OAT. Odds of OAT receipt were significantly higher odds among blacks (OR: 2.27(2.14–2.41)) and Hispanics (OR: 1.98(1.88–2.09)), compared to whites. Differences in clinical need accounted for a substantial portion of this difference (76.79{\%} and 49.74{\%}, respectively). Differences persisted after accounting for other potential explanatory variables (adjusted OR: 1.37 (1.24–1.52); 1.21(1.11–1.32)), but were only evident for primary heroin users (adjusted OR: 1.50 (1.34–1.69); 1.29 (1.17–1.42)) and not other opioid users. Conclusions OAT receipt in treatment programs is low overall and particularly lacking among white heroin users. Differences in OAT receipt cannot be fully explained by differences in clinical need. More research is needed to understand and address barriers that underpin these differences so more patients with opioid use disorder can access evidenced-based treatment.",
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AU - Saloner, Brendan

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N2 - Background Opioid Agonist Treatment (OAT) is the standard of care for the treatment of opioid use disorders. However, most people in treatment do not receive OAT. This study evaluated whether there are racial and/or ethnic differences in OAT receipt among adults entering specialty treatment for opioid use disorders in publicly-funded treatment programs across the U.S. Methods Using data from the national Treatment: Episode Data Base, odds of OAT receipt were compared among black, Hispanic and white clients. Mediation analyses were used to explore whether any racial/ethnic differences in OAT receipt were explained by variation in clinical need or by other treatment, sociodemographic, or geographic characteristics. Interaction terms were used to assess whether this association was modified by primary opioid type. Results Only 28.7% of clients received OAT. Odds of OAT receipt were significantly higher odds among blacks (OR: 2.27(2.14–2.41)) and Hispanics (OR: 1.98(1.88–2.09)), compared to whites. Differences in clinical need accounted for a substantial portion of this difference (76.79% and 49.74%, respectively). Differences persisted after accounting for other potential explanatory variables (adjusted OR: 1.37 (1.24–1.52); 1.21(1.11–1.32)), but were only evident for primary heroin users (adjusted OR: 1.50 (1.34–1.69); 1.29 (1.17–1.42)) and not other opioid users. Conclusions OAT receipt in treatment programs is low overall and particularly lacking among white heroin users. Differences in OAT receipt cannot be fully explained by differences in clinical need. More research is needed to understand and address barriers that underpin these differences so more patients with opioid use disorder can access evidenced-based treatment.

AB - Background Opioid Agonist Treatment (OAT) is the standard of care for the treatment of opioid use disorders. However, most people in treatment do not receive OAT. This study evaluated whether there are racial and/or ethnic differences in OAT receipt among adults entering specialty treatment for opioid use disorders in publicly-funded treatment programs across the U.S. Methods Using data from the national Treatment: Episode Data Base, odds of OAT receipt were compared among black, Hispanic and white clients. Mediation analyses were used to explore whether any racial/ethnic differences in OAT receipt were explained by variation in clinical need or by other treatment, sociodemographic, or geographic characteristics. Interaction terms were used to assess whether this association was modified by primary opioid type. Results Only 28.7% of clients received OAT. Odds of OAT receipt were significantly higher odds among blacks (OR: 2.27(2.14–2.41)) and Hispanics (OR: 1.98(1.88–2.09)), compared to whites. Differences in clinical need accounted for a substantial portion of this difference (76.79% and 49.74%, respectively). Differences persisted after accounting for other potential explanatory variables (adjusted OR: 1.37 (1.24–1.52); 1.21(1.11–1.32)), but were only evident for primary heroin users (adjusted OR: 1.50 (1.34–1.69); 1.29 (1.17–1.42)) and not other opioid users. Conclusions OAT receipt in treatment programs is low overall and particularly lacking among white heroin users. Differences in OAT receipt cannot be fully explained by differences in clinical need. More research is needed to understand and address barriers that underpin these differences so more patients with opioid use disorder can access evidenced-based treatment.

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KW - Medication assisted treatment

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KW - Opioid treatment programs

KW - Opioid use disorder

KW - Racial disparities

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