Gender disparities in opioid treatment progress in methadone versus counseling
Abstract Background In the United States, the high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress in treatment. Whereas counseling and medication for OUD (MOUD, e.g. methadone, bupr...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-06-01
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| Series: | Substance Abuse Treatment, Prevention, and Policy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13011-021-00389-4 |
| _version_ | 1819083820968706048 |
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| author | Erick Guerrero Hortensia Amaro Yinfei Kong Tenie Khachikian Jeanne C. Marsh |
| author_facet | Erick Guerrero Hortensia Amaro Yinfei Kong Tenie Khachikian Jeanne C. Marsh |
| author_sort | Erick Guerrero |
| collection | DOAJ |
| description | Abstract Background In the United States, the high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress in treatment. Whereas counseling and medication for OUD (MOUD, e.g. methadone, buprenorphine, naltrexone) is considered the gold standard of care in substance use disorder (SUD) treatment, many individuals with OUD receive either counseling or methadone-only services. This study evaluates gender disparities in treatment plan progress in methadone- compared to counseling-based programs in one of the largest SUD treatment systems in the United States. Methods Multi-year and multi-level (treatment program and client-level) data were analyzed using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset collected in Los Angeles County, California. The sample consisted of 4 waves: 2011 (66 SUD programs, 1035 clients), 2013 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients). We conducted two multi-level negative binomial regressions, one per each outcome (1) making progress towards completing treatment plan, and (2) completing treatment plan. We included outpatient clients discharged on each of the years of the study (over 95% of all clients) and accounted for demographics, wave, homelessness and prior treatment episodes, as well as clients clustered within programs. Results We detected gender differences in two treatment outcomes (progress and completion) considering two outpatient program service types (MOUD-methadone vs. counseling). Clients who received methadone vs. counseling had lower odds of completing their treatment plan (OR = 0.366; 95% CI = 0.163, 0.821). Female clients receiving methadone had lower odds of both making progress (OR = 0.668; 95% CI = 0.481, 0.929) and completing their treatment plan (OR = 0.666; 95% CI = 0.485, 0.916) compared to male clients and receiving counseling. Latina clients had lower odds of completing their treatment plan (OR = 0.617; 95% CI = 0.408, 0.934) compared with non-Latina clients. Conclusions Clients receiving methadone, the most common and highly effective MOUD in reducing opioid use, were less likely to make progress towards or complete their treatment plan than those receiving counseling. Women, and in particular those identified as Latinas, were least likely to benefit from methadone-based programs. These findings have implications for health policy and program design that consider the need for comprehensive and culturally responsive services in methadone-based programs to improve outpatient treatment outcomes among women. |
| first_indexed | 2024-12-21T20:38:39Z |
| format | Article |
| id | doaj.art-0efdcf4bb03c497d82ef643f53ac24e2 |
| institution | Directory Open Access Journal |
| issn | 1747-597X |
| language | English |
| last_indexed | 2024-12-21T20:38:39Z |
| publishDate | 2021-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Substance Abuse Treatment, Prevention, and Policy |
| spelling | doaj.art-0efdcf4bb03c497d82ef643f53ac24e22022-12-21T18:51:01ZengBMCSubstance Abuse Treatment, Prevention, and Policy1747-597X2021-06-0116111010.1186/s13011-021-00389-4Gender disparities in opioid treatment progress in methadone versus counselingErick Guerrero0Hortensia Amaro1Yinfei Kong2Tenie Khachikian3Jeanne C. Marsh4I-Lead Institute, Research to End Health Disparities CorpHerbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International UniversityCollege of Business and Economics, California State University FullertonCrown Family School of Social Work, Policy, and Practice, University of ChicagoCrown Family School of Social Work, Policy, and Practice, University of ChicagoAbstract Background In the United States, the high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress in treatment. Whereas counseling and medication for OUD (MOUD, e.g. methadone, buprenorphine, naltrexone) is considered the gold standard of care in substance use disorder (SUD) treatment, many individuals with OUD receive either counseling or methadone-only services. This study evaluates gender disparities in treatment plan progress in methadone- compared to counseling-based programs in one of the largest SUD treatment systems in the United States. Methods Multi-year and multi-level (treatment program and client-level) data were analyzed using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset collected in Los Angeles County, California. The sample consisted of 4 waves: 2011 (66 SUD programs, 1035 clients), 2013 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients). We conducted two multi-level negative binomial regressions, one per each outcome (1) making progress towards completing treatment plan, and (2) completing treatment plan. We included outpatient clients discharged on each of the years of the study (over 95% of all clients) and accounted for demographics, wave, homelessness and prior treatment episodes, as well as clients clustered within programs. Results We detected gender differences in two treatment outcomes (progress and completion) considering two outpatient program service types (MOUD-methadone vs. counseling). Clients who received methadone vs. counseling had lower odds of completing their treatment plan (OR = 0.366; 95% CI = 0.163, 0.821). Female clients receiving methadone had lower odds of both making progress (OR = 0.668; 95% CI = 0.481, 0.929) and completing their treatment plan (OR = 0.666; 95% CI = 0.485, 0.916) compared to male clients and receiving counseling. Latina clients had lower odds of completing their treatment plan (OR = 0.617; 95% CI = 0.408, 0.934) compared with non-Latina clients. Conclusions Clients receiving methadone, the most common and highly effective MOUD in reducing opioid use, were less likely to make progress towards or complete their treatment plan than those receiving counseling. Women, and in particular those identified as Latinas, were least likely to benefit from methadone-based programs. These findings have implications for health policy and program design that consider the need for comprehensive and culturally responsive services in methadone-based programs to improve outpatient treatment outcomes among women.https://doi.org/10.1186/s13011-021-00389-4Gender disparitiesTreatment progressOpioid useMOUDCounselingMethadone |
| spellingShingle | Erick Guerrero Hortensia Amaro Yinfei Kong Tenie Khachikian Jeanne C. Marsh Gender disparities in opioid treatment progress in methadone versus counseling Substance Abuse Treatment, Prevention, and Policy Gender disparities Treatment progress Opioid use MOUD Counseling Methadone |
| title | Gender disparities in opioid treatment progress in methadone versus counseling |
| title_full | Gender disparities in opioid treatment progress in methadone versus counseling |
| title_fullStr | Gender disparities in opioid treatment progress in methadone versus counseling |
| title_full_unstemmed | Gender disparities in opioid treatment progress in methadone versus counseling |
| title_short | Gender disparities in opioid treatment progress in methadone versus counseling |
| title_sort | gender disparities in opioid treatment progress in methadone versus counseling |
| topic | Gender disparities Treatment progress Opioid use MOUD Counseling Methadone |
| url | https://doi.org/10.1186/s13011-021-00389-4 |
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