Racial and ethnic differences in opioid agonist treatment for opioid use disorder in a U.S. national sample (original) (raw)
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Improving Research on Racial Disparities in Access to Medications to Treat Opioid Use Disorders
Journal of Addiction Medicine, 2022
The aims of the study are to review the current research on the association between access to medications for opioid use disorders (MOUD) and race, to identify gaps in research methods, and to propose new approaches to end racialized disparities in access to MOUD. Methods: We conducted a literature review of English language peer-reviewed published literature from 2010 to 2021 to identify research studies examining the association between race and use of, or access to, MOUD. Results: We reviewed 21 studies related to access to MOUD for Black and White populations. Of the 21 studies, 16 found that Black individuals had lower use of, or access to, MOUD than White individuals, 2 found the opposite among patients in specialty addiction treatment, 1 found that the difference changed over time, and 2 found that distance to opioid treatment programs was shorter for Black residents than for White residents. Conclusions: To improve future research, we recommend that researchers (1) be clearer on how race is conceptualized and interpreted; (2) explicitly evaluate the intersection of race and other factors that may influence access such as income, insurance status, and geography; (3) use measures of perceived racism, unconscious bias, and self-identified race; (4) collect narratives to better understand why race is associated with lower MOUD access and identify solutions; and (5) evaluate the effect of policies, programs, and clinical training on reducing racial disparities. A multitude of studies find that Black individuals have lower access to MOUD. Researchers must now identify effective solutions for reducing these disparities.
Drug and Alcohol Dependence, 2018
Background: The present study examined racial/ethnic disparities in initial treatment episode completion for adult clients reporting opioids as their primary problem substance in large US metropolitan areas. Methods: Data were extracted from the 2013 TEDS-D dataset (Treatment Episode Dataset-Discharge) for the 42 largest US metropolitan statistical areas (MSAs). Fixed effects logistic regression controlling for MSA was used to estimate the effect of race/ethnicity on the likelihood of treatment completion. The model was repeated for each individual MSA in a stratified design to compare the geographic variation in racial/ethnic disparities, controlling for gender, age, education, employment, living arrangement, treatment setting, medication-assisted treatment, referral source, route of administration, and number of substances used at admission. Results: Only 28% of clients completed treatment, and the results from the fixed effects model indicate that blacks and Hispanics are less likely to complete treatment compared to whites. However, the stratified analysis of individual MSAs found only three of the 42 MSAs had racial/ethnic disparities in treatment completion, with the New York City (NYC) MSA largely responsible for the disparities in the combined sample. Supplementary analyses suggest that there are greater differences between whites and minority clients in the NYC MSA vs. other cities on characteristics associated with treatment completion (e.g., residential treatment setting). Conclusion: This study underscores the need for improving treatment retention for all opioid using clients in large metropolitan areas in the US, particularly for minority clients in those localities where disparities exist, and for better understanding the geographic context for treatment outcomes. Farrelly, 2017; Franklin et al., 2015; Murphy et al., 2016). One of the most widely used proximal measures of treatment effectiveness for substance use disorders (SUDs) is treatment completion (Brorson et al., 2013), generally defined as successfully completing treatment goals (Greenfield et al., 2007). Despite evidence showing sustained recovery may involve multiple episodes over time (Guerrero, 2013; McKay and Weiss, 2001), individual treatment completion episodes can serve as an important indicator associated with longer term abstinence, fewer relapses, higher levels of employment, higher wages, fewer readmissions, less future criminal involvement, and better health (Brorson et al., 2013). Black and Hispanic people in the US tend to have lower treatment utilization rates, greater barriers to receiving treatment, and poorer outcomes, including treatment completion, compared to white clients
Racial differences in opioid use for chronic nonmalignant pain
Journal of General Internal Medicine, 2005
BACKGROUND: Chronic pain is a frequent cause of suffering and disability that negatively affects patients’ quality of life. There is growing evidence that disparities in the treatment of pain occur because of differences in race. OBJECTIVE: To determine whether race plays a role in treatment decisions involving patients with chronic nonmalignant pain in a primary care population. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey was administered to patients with chronic nonmalignant pain and their treating physicians at 12 academic medical centers. We enrolled 463 patients with nonmalignant pain persisting for more than 3 consecutive months and the primary care physicians participating in their care. RESULTS: Analysis of the 397 black and white patients showed that blacks had significantly higher pain scores (6.7 on a scale of 0 to 10, 95% confidence interval (CI) 6.4 to 7.0) compared with whites (5.6, 95% CI 5.3 to 5.9); however, white patients were more likely to be taking opioid analgesics compared with blacks (45.7% vs 32.2%, P<.006). Even after controlling for potentially confounding variables, white patients were significantly more likely (odds ratio (OR) 2.67, 95% CI 1.71 to 4.15) to be taking opioid analgesics than black patients. There were no differences by race in the use of other treatment modalities such as physical therapy and nonsteroidal anti-inflammatories or in the use of specialty referral. CONCLUSION: Equal treatment by race occurs in nonopioid-related therapies, but white patients are more likely than black patients to be treated with opioids. Further studies are needed to better explain this racial difference and define its effect on patient outcomes.
Effects of ethnicity on low-dose opiate stabilization
Journal of substance abuse treatment
In a recent randomized clinical trial using buprenorphine (2 and 6 mg) and methadone (35 and 65 mg), we compared low-level opiate withdrawal symptoms among Whites (n = 84), Hispanics (n = 20), and African Americans (n = 21). During the first 2 months of opiate stabilization, persistent low-level opiate withdrawal symptoms were significantly lower in African-Americans and Hispanics than in the white patients. As expected pharmacologically, this relative underreporting of low-level withdrawal by minority patients was greater for the low opiate doses (buprenorphine 2 mg and methadone 35 mg). This underreporting may reflect sociocultural as well as biological differences, because subjective, but not objective, withdrawal symptoms showed this ethnic difference.
Background: This study examines changing patterns of past-year heroin use and heroin-related risk behav- iors among individuals with nonmedical use of prescription opioids (NMUPO) by racial/ethnic groups in the United States. Methods: We used data from the National Survey on Drug Use and Health (NSDUH) from 2002 to 2005 and 2008 to 2011, resulting in a total sample of N = 448,597. Results: Past-year heroin use increased among individuals with NMUPO and increases varied by frequency of past year NMUPO and race/ethnicity. Those with NMUPO in the 2008–2011 period had almost twice the odds of heroin use as those with NMUPO in the 2002–2005 period (OR = 1.89, 95%CI: 1.50, 2.39), with higher increases in non-Hispanic (NH) Whites and Hispanics. In 2008–2011, the risk of past year heroin use, ever injecting heroin, past-year heroin abuse or dependence, and the perception of availability of heroin increased as the frequency of NMUPO increased across respondents of all race/ethnicities. Conclusion: Individuals with NMUPO, particularly non-Hispanic Whites, are at high risk of heroin use and heroin-related risk behaviors. These results suggest that frequent nonmedical users of prescription opioids, regardless of race/ethnicity, should be the focus of novel public health efforts to prevent and mitigate the harms of heroin use.
Exploring the impact of the opioid epidemic in Black and Hispanic communities in the United States
Drug Science, Policy and Law, 2020
Context: In recent years, due to an alarming increase in the number of opioid-related overdose fatalities for White, Non-Hispanics in rural and suburban communities across the United States, they have been considered as the face of this epidemic. However, there has also been a staggering rise in the number of opioid overdoses in urban, minority communities, which have not been thoroughly addressed by the literature. Methods We reviewed deaths where opioid-related substances were reported as the leading cause of death to the Centers of Disease Control Multiple Cause of Death database from 1999 to 2017. Deaths were analyzed by year, State, drug type, and race and ethnicity. Results There were 399,230 total opioid-related deaths from 1999 to 2017 amongst all ethnic groups in the U.S. During this timeframe, approximately 323,939 total deaths were attributed to White, Non-Hispanics, while 75,291 were attributed to all other ethnicities. Examination of opioid-related overdose death data b...
Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments
Jama-journal of The American Medical Association, 2008
Context National quality improvement initiatives implemented in the late 1990s were followed by substantial increases in opioid prescribing in the United States, but it is unknown whether opioid prescribing for treatment of pain in the emergency department has increased and whether differences in opioid prescribing by race/ethnicity have decreased.
Jouranl of Public Health Issues and Practices, 2021
Methods: Data were abstracted from secondary data sources, including the Louisiana Opioid Data and Surveillance System. Trends in opioid-involved deaths, drug-induced deaths, and opioid prescription by prescriber location were determined in the U.S. and Louisiana. Results: The increasing trends in age-adjusted rate of opioidinvolved deaths in Louisiana has mimicked what has occurred in the United States.The crude rates of drug-induced deaths in the U.S. and Louisiana exhibited an increasing trend. However, the trend in opioid prescriptions had a decreasing trend.The crude rates were higher in non-Hispanic Whites, as well as in males. This trend is changing with the gap between opioid-involved deaths among non-Hispanic Whites and non-Hispanic Blacks narrowing, as well as between males and females. Conclusions: The study confirmed that the opioid epidemic in the U.S. is also occurring in Louisiana. The changing trends in the rate of opioid-involved deaths indicate anarrowing of the gap between non-Hispanic Whites and non-Hispanic Blacks, and males and females, and that public health practice and health policy must address the future needs to mitigate the opioid epidemic.
Martins Racial:ethnic differences in trends in heroin use
Background: This study examines changing patterns of past-year heroin use and heroin-related risk behaviors among individuals with nonmedical use of prescription opioids (NMUPO) by racial/ethnic groups in the United States. Methods: We used data from the National Survey on Drug Use and Health (NSDUH) from 2002 to 2005 and 2008 to 2011, resulting in a total sample of N = 448,597. Results: Past-year heroin use increased among individuals with NMUPO and increases varied by frequency of past year NMUPO and race/ethnicity. Those with NMUPO in the 2008-2011 period had almost twice the odds of heroin use as those with NMUPO in the 2002-2005 period (OR = 1.89, 95%CI: 1.50, 2.39), with higher increases in non-Hispanic (NH) Whites and Hispanics.
Journal of General Internal Medicine, 2013
BACKGROUND: Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described, yet the influence of socioeconomic status (SES) remains unclear. OBJECTIVES: (1) To examine the effect of neighborhood SES on the prescribing of opioids for moderate to severe pain; and (2) to determine if racial disparities in opioid prescribing persist after accounting for SES. DESIGN: We used cross-sectional data from the National Hospital Ambulatory Medical Care Survey between 2006 and 2009 to examine the prescribing of opioids to patients presenting with moderate to severe pain (184 million visits). We used logistic regression to examine the association between the prescribing of opioids, SES, and race. Models were adjusted for age, sex, pain-level, injury-status, frequency of emergency visits, hospital type, and region. MAIN MEASURES: Our primary outcome measure was whether an opioid was prescribed during a visit for moderate to severe pain. SES was determined based on income, percent poverty, and educational level within a patient's zip code. RESULTS: Opioids were prescribed more frequently at visits from patients of the highest SES quartile compared to patients in the lowest quartile, including percent poverty (49.0 % vs. 39.4 %, P<0.001), household income (47.3 % vs. 40.7 %, P < 0.001), and educational level (46.3 % vs. 42.5 %, P=0.01). Black patients were prescribed opioids less frequently than white patients across all measures of SES. In adjusted models, black patients (AOR 0.73; 95 % CI 0.66-0.81) and patients from poorer areas (AOR 0.76; 95 % CI 0.68-0.86) were less likely to receive opioids after accounting for pain-level, age, injury-status, and other covariates. CONCLUSIONS: Patients presenting to emergency departments from lower SES regions were less likely to receive opioids for equivalent levels of pain than those from more affluent areas. Black and Hispanic patients were also less likely to receive opioids for equivalent levels of pain than whites, independent of SES.