Racial/ethnic equity in substance use treatment research: the way forward (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.
Measurement and Data Analysis in Research Addressing Health Disparities in Substance Abuse
This paper describes concrete strategies for conducting substance abuse research with Ethnic Minorities. Two issues associated with valid analysis, measurement and data analysis, are included. Both empirical (e.g., Confirmatory Factor Analysis, Item Response Theory, and regression) and nonempirical (e.g., focus groups, expert panels, pilot studies and translation equivalence) approaches to improving measures are described. A discussion of the use of norms and cutoff scores derived from a different ethnic group along with the effects of the ethnicity of the interviewer or coder on measurement is included. The section on data analysis describes why the use of race comparison designs may lead to misleading conclusions. Alternatives to race comparison analysis including within group and between group analyses are described. The shortcomings of combining ethnic groups for analyses are discussed. The paper ends with a list of recommendations for research with Ethnic Minorities.
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
Drug and Alcohol Dependence, 2017
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
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.
Disparities in Completion of Substance Abuse Treatment between and within Racial and Ethnic Groups
Health Services Research, 2013
Objective. To evaluate disparities in substance abuse treatment completion between and within racial and ethnic groups in publicly funded treatment in Los Angeles County, California. Data Source. The Los Angeles County Participant Reporting System with multicross-sectional annual data (2006)(2007)(2008)(2009) for adult participants (n = 16,637) who received treatment from publicly funded programs (n = 276) for the first time. Study Design. Retrospective analyses of county discharge and admission data. Hierarchical linear regressions models were used to test the hypotheses. Data Collection. Client data were collected during personal interviews at admission and discharge for most participants. Principal Findings. African Americans and Latinos reported lower odds of completing treatment compared with Whites. Within-group analysis revealed significant heterogeneity within racial and ethnic groups, highlighting primary drug problem, days of drug use before admission, and homelessness as significant factors affecting treatment completion. Service factors, such as referral by the criminal justice system, enabled completion among Latinos and Whites only. Conclusions. These findings have implications for reducing health disparities among members of racial and ethnic minorities by identifying individual and service factors associated with treatment adherence, particularly for first-time clients.
An Evaluation of Opioid Use in Black Communities: A Rapid Review of the Literature
Harvard Review of Psychiatry, 2021
Background.There are multiple aspects of the opioid crisis among Black people, who have been left out of the broader conversation. Despite evidence of increased opioid overdose deaths, less is known about opioid use among Black people. This review synthesizes research on Black people who use opioids; the goals are to advance knowledge, highlight research gaps, and inform clinical practice.Methods.This rapid review investigating opioid use among Black people utilized systematic review methods and was conducted according to a predefined protocol with clear inclusion criteria (PROSPERO ID: 177071). A comprehensive search strategy was used, including published and gray literature sources (i.e., literature that has not been formally published). A narrative summary of the results is presented.Results.A total of 76 works were selected for inclusion and full text review. Gender, age, geographic location, and involvement in the carceral system were associated with the use of opioids among Black individuals. Non-epidemiological factors included treatment-seeking patterns, disparate clinician prescribing, and social determinants.Conclusions.Through this rapid review we suggest three main areas of focus: (1) including culturally informed collection methods in epidemiological surveys to accurately reflect prevalences, (2) funding research that specifically addresses the importance of culture in accessing treatment, and (3) directly studying how social determinants can improve or exacerbate health outcomes. Focusing on the unique needs of Black people who use opioids is warranted to increase treatment initiation and adherence among a population less likely to engage with the traditional health care system.
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...
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.