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Abstract：
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.
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.
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.
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.
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.
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.
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.
摘要：
在美国,在女性和种族/族裔少数群体中,阿片类药物使用障碍(OUD)治疗的高辍学率(75%)需要理解有助于治疗进展的因素.鉴于OUD的咨询和药物(MOUD，例如美沙酮,丁丙诺啡,纳曲酮）被认为是物质使用障碍（SUD）治疗的黄金标准，许多OUD患者接受咨询或美沙酮服务。这项研究评估了美沙酮治疗计划进展中的性别差异-与美国最大的SUD治疗系统之一的咨询计划相比。
使用在洛杉矶县收集的综合药物滥用治疗消除差异（iSATed）数据集分析了多年和多层次（治疗计划和客户水平）数据，加州样本包括4波：2011年(66个SUD项目，1035个客户)，2013(77个SUD计划，3686个客户），2015年(75个SUD项目，4626个客户)，和2017年(69个SUD项目，4106个客户）。我们进行了两次多级负二项回归，每个结果(1)在完成治疗计划方面取得进展，（2）完成治疗计划。我们包括在研究的每一年出院的门诊客户（超过所有客户的95％），并考虑人口统计学，波浪,无家可归和先前的治疗事件，以及聚集在程序中的客户端。
我们在考虑两种门诊项目服务类型（MOUD-美沙酮vs.咨询)。接受美沙酮的客户与咨询完成治疗计划的几率较低(OR=0.366;95%CI=0.163,0.821).与接受咨询的男性客户相比，接受美沙酮的女性客户取得进展（OR=0.668；95％CI=0.481，0.929）和完成治疗计划（OR=0.666；95％CI=0.485，0.916）的几率较低。与非拉丁裔客户相比，拉丁裔客户完成治疗计划的几率较低（OR=0.617；95％CI=0.408，0.934）。
接受美沙酮的客户，减少阿片类药物使用的最常见和最有效的MOUD，与接受咨询的人相比，他们不太可能取得进展或完成他们的治疗计划。女人,特别是那些被认定为拉丁裔的人，最不可能从美沙酮计划中受益。这些发现对卫生政策和计划设计具有启示意义，这些政策和计划考虑了在基于美沙酮的计划中需要全面和文化上敏感的服务，以改善女性的门诊治疗结果。
使用在洛杉矶县收集的综合药物滥用治疗消除差异（iSATed）数据集分析了多年和多层次（治疗计划和客户水平）数据，加州样本包括4波：2011年(66个SUD项目，1035个客户)，2013(77个SUD计划，3686个客户），2015年(75个SUD项目，4626个客户)，和2017年(69个SUD项目，4106个客户）。我们进行了两次多级负二项回归，每个结果(1)在完成治疗计划方面取得进展，（2）完成治疗计划。我们包括在研究的每一年出院的门诊客户（超过所有客户的95％），并考虑人口统计学，波浪,无家可归和先前的治疗事件，以及聚集在程序中的客户端。
我们在考虑两种门诊项目服务类型（MOUD-美沙酮vs.咨询)。接受美沙酮的客户与咨询完成治疗计划的几率较低(OR=0.366;95%CI=0.163,0.821).与接受咨询的男性客户相比，接受美沙酮的女性客户取得进展（OR=0.668；95％CI=0.481，0.929）和完成治疗计划（OR=0.666；95％CI=0.485，0.916）的几率较低。与非拉丁裔客户相比，拉丁裔客户完成治疗计划的几率较低（OR=0.617；95％CI=0.408，0.934）。
接受美沙酮的客户，减少阿片类药物使用的最常见和最有效的MOUD，与接受咨询的人相比，他们不太可能取得进展或完成他们的治疗计划。女人,特别是那些被认定为拉丁裔的人，最不可能从美沙酮计划中受益。这些发现对卫生政策和计划设计具有启示意义，这些政策和计划考虑了在基于美沙酮的计划中需要全面和文化上敏感的服务，以改善女性的门诊治疗结果。
