Association of Racial/Ethnic Segregation With Treatment Capacity for Opioid Use Disorder in Counties in the United States
Association of Racial/Ethnic Segregation With Treatment Capacity for Opioid Use Disorder in Counties in the United States
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DOI：
10.1001/jamanetworkopen.2020.3711
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发表时间：
2020-04-22
影响因子：
13.8
通讯作者：
Marshall, Brandon D. L.
中科院分区：
文献类型：
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作者：
Goedel, William C.;Shapiro, Aaron;Marshall, Brandon D. L.
县级提供美沙酮和丁丙诺啡的能力是否因种族/民族隔离措施而异？在2016年美国所有3142个县或县当量单位的横断研究中，高度隔离的非洲裔美国人和西班牙裔/拉丁裔社区的县人均提供美沙酮的设施更多，而高度隔离的白人社区的县人均提供丁丙诺啡的设施更多。这些发现表明，有必要进行政策改革，以确保所有阿片类药物使用障碍患者平等获得美沙酮和丁丙诺啡。本横断面研究考察了美国种族/民族隔离与县一级美沙酮和丁丙诺啡可用性的关系。美沙酮或丁丙诺啡治疗是目前阿片类药物使用障碍的标准治疗方法。鉴于缺乏确定哪些患者对哪种药物反应最好的研究，这两种药物应该对所有患者开放，以便患者可以确定哪种药物对他们最有效。然而，由于其最初实施的历史背景不同，这些药物的可及性可能因种族/民族而异。目的探讨美沙酮和丁丙诺啡的提供能力在多大程度上随种族/民族隔离措施而变化。设计、环境和参与者本横断面研究包括2016年美国所有县和同等县的分区。种族/族裔人口分布数据来自美国社区调查，提供美沙酮和丁丙诺啡的设施地点数据来自药物滥用和精神卫生服务管理局的数据库。数据分析时间为2018年8月22日至2019年9月11日。两种县级种族/民族隔离措施，包括差异性（代表非裔美国人或西班牙裔/拉丁裔居民需要移动人口普查区以实现人口按种族/民族的均匀空间分布的比例）和互动性（代表非裔美国人或西班牙裔/拉丁裔居民与白人居民互动的概率，反之亦然，假设人口普查区随机混合）。县级提供美沙酮或丁丙诺啡的能力，定义为每10万人中提供一种药物的设施数量。结果在美国3142个县中，美沙酮和丁丙诺啡分别有1698个和18868个县，美沙酮和丁丙诺啡分别有0.6个和5.9个县。非裔美国居民与白人居民相互作用的概率每降低1%，每10万人中就会有0.6家提供美沙酮的机构。同样，西班牙裔/拉丁裔居民与白人居民互动的概率每降低1%，每10万人中提供美沙酮的设施就会增加0.3个。白人居民与非裔美国人居民相互作用的概率每降低1%，每10万人中提供丁丙诺啡的设施就会增加8.17个。同样，白人居民与西班牙裔/拉丁裔居民相互作用的概率每降低1%，每10万人中提供丁丙诺啡的设施就会增加1.61个。结论和相关性这些发现表明，社区的种族/民族组成与居民在寻求阿片类药物使用障碍治疗时可能能够获得的药物有关。需要对管理这些药物供应的现行法规进行改革，以确保所有人都能平等地获得这两种药物。
Question Does county-level capacity to provide methadone and buprenorphine vary with measures of racial/ethnic segregation? Findings In this cross-sectional study of all 3142 counties or county-equivalent units in the US in 2016, counties with highly segregated African American and Hispanic/Latino communities had more facilities to provide methadone per capita, while counties with highly segregated white communities had more facilities to provide buprenorphine per capita. Meaning These findings suggest that policy reforms are warranted to ensure equal access to both methadone and buprenorphine among all patients with opioid use disorder.This cross-sectional study examines the associations of racial/ethnic segregation with county-level availability of methadone and buprenorphine in the US.Importance Treatment with methadone or buprenorphine is the current standard of care for opioid use disorder. Given the paucity of research identifying which patients will respond best to which medication, both medications should be accessible to all patients so that patients can determine which works best for them. However, given differences in the historical contexts of their initial implementation, access to each of these medications may vary along racial/ethnic lines. Objective To examine the extent to which capacity to provide methadone and buprenorphine vary with measures of racial/ethnic segregation. Design, Setting, and Participants This cross-sectional study included all counties and county-equivalent divisions in the US in 2016. Data on racial/ethnic population distribution were derived from the American Community Survey, and data on locations of facilities providing methadone and buprenorphine were obtained from Substance Abuse and Mental Health Services Administration databases. Data were analyzed from August 22, 2018, to September 11, 2019. Exposures Two county-level measures of racial/ethnic segregation, including dissimilarity (representing the proportion of African American or Hispanic/Latino residents who would need to move census tracts to achieve a uniform spatial distribution of the population by race/ethnicity) and interaction (representing the probability that an African American or Hispanic/Latino resident will interact with a white resident and vice versa, assuming random mixing across census tracts). Main Outcomes and Measures County-level capacity to provide methadone or buprenorphine, defined as the number of facilities providing a medication per 100 000 population. Results Among 3142 US counties, there were 1698 facilities providing methadone (0.6 facilities per 100 000 population) and 18 868 facilities providing buprenorphine (5.9 facilities per 100 000 population). Each 1% decrease in probability of interaction of an African American resident with a white resident was associated with 0.6 more facilities providing methadone per 100 000 population. Similarly, each 1% decrease in probability of interaction of a Hispanic/Latino resident with a white resident was associated with 0.3 more facilities providing methadone per 100 000 population. Each 1% decrease in the probability of interaction of a white resident with an African American resident was associated with 8.17 more facilities providing buprenorphine per 100 000 population. Similarly, each 1% decrease in the probability of interaction of a white resident with a Hispanic/Latino resident was associated with 1.61 more facilities providing buprenorphine per 100 000 population. Conclusions and Relevance These findings suggest that the racial/ethnic composition of a community was associated with which medications residents would likely be able to access when seeking treatment for opioid use disorder. Reforms to existing regulations governing the provisions of these medications are needed to ensure that both medications are equally accessible to all.