Racial and ethnic differences in opioid agonist treatment for opioid use disorder in a US national sample
Racial and ethnic differences in opioid agonist treatment for opioid use disorder in a US national sample
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DOI：
10.1016/j.drugalcdep.2017.06.009
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发表时间：
2017-09-01
影响因子：
4.2
通讯作者：
Saloner, Brendan
中科院分区：
文献类型：
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作者：
Krawczyk, Noa;Feder, Kenneth A.;Saloner, Brendan
背景：阿片类药物激动剂治疗（OAT）是阿片类药物使用障碍的标准治疗。然而，大多数接受治疗的人不接受OAT。本研究评估了是否有种族和/或种族差异OAT接收成人进入阿片类药物使用障碍的专业治疗在公共资助的治疗方案在美国各地的方法：使用国家治疗的数据：发作数据库，OAT接收的几率进行了比较黑人，西班牙裔和白色客户。中介分析用于探讨OAT治疗中的任何种族/民族差异是否可以通过临床需求的变化或其他治疗、社会人口统计学或地理特征来解释。相互作用的条款被用来评估这种关联是否被修改的主要阿片类type.Results：只有28.7%的客户端接受OAT。与白人相比，黑人（OR：2.27（2.14-2.41））和西班牙裔（OR：1.98（1.88-2.09））接受OAT的几率显著更高。临床需求差异占该差异的很大一部分（分别为76.79%和49.74%）。在考虑了其他潜在的解释变量后，（调整OR：1.37（1.24-1.52）; 1.21（1.11-1.32）），但仅在海洛因初次使用者中明显（调整后的OR：1.50（1.34-1.69）; 1.29（1.17-1.42）），而不是其他阿片类药物使用者。结论：OAT在治疗方案中的接受率总体较低，尤其是在白色海洛因使用者中缺乏。临床需求的差异不能完全解释OAT接收的差异。需要更多的研究来了解和解决支撑这些差异的障碍，以便更多的阿片类药物使用障碍患者能够获得循证治疗。
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.