Noa Krawczyk1, Kenneth A Feder2, Michael I Fingerhood3, Brendan Saloner4. 1. Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N. Broadway, Baltimore, MD, 21205, United States. Electronic address: noa.krawczyk@jhu.edu. 2. Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N. Broadway, Baltimore, MD, 21205, United States. 3. Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N. Broadway, Baltimore, MD, 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, United States. 4. Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N. Broadway, Baltimore, MD, 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 N. Broadway, Baltimore, MD, 21205, United States.
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.
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.
Authors: Christopher M Jones; Joseph Logan; R Matthew Gladden; Michele K Bohm Journal: MMWR Morb Mortal Wkly Rep Date: 2015-07-10 Impact factor: 17.586
Authors: Kayla N Tormohlen; Noa Krawczyk; Kenneth A Feder; Kira E Riehm; Rosa M Crum; Ramin Mojtabai Journal: Health Serv Res Date: 2019-12-29 Impact factor: 3.402
Authors: Noa Krawczyk; Ramin Mojtabai; Elizabeth A Stuart; Michael Fingerhood; Deborah Agus; B Casey Lyons; Jonathan P Weiner; Brendan Saloner Journal: Addiction Date: 2020-02-24 Impact factor: 6.526