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Gender disparities in opioid treatment progress in methadone versus counseling

机译：阿甲酸NO的阿片类药物治疗进展的性别差异与咨询

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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.
机译：在美国，阿片类药物和种族/少数群体中的阿片类药物使用障碍（Oud）治疗的高辍学率（75％）要求理解有助于取得待遇的因素。虽然Oud（Moud，例如Moud.美容，丁丙诺啡，纳丙酮）被认为是物质使用障碍（SUD）治疗的黄金护理标准，但许多有oud的个体接受辅导或仅限美沙酮的服务。本研究评估了与美国最大的泡沫治疗系统中的咨询方案相比，评估了对美沙酮的治疗计划进展的性别差异。使用综合物质滥用处理分析了多年和多级（治疗方案和客户级）数据，以消除加利福尼亚州洛杉矶县收集的差距（Isated）数据集。该样本由4波：2011（66个SUD计划，1035个客户），2013（77 SUD计划，3686客户），2015（75个SUD计划，4626客户）和2017（69个SUD计划，4106个客户）。我们进行了两种多级负二项式回归，每个结果（1）为完成待遇计划，（2）完成待遇计划。我们包括在研究年度的每年（占所有客户的95％）上发出的门诊客户，并占人口统计，波，无家可归和先前治疗剧集，以及在方案中聚集的客户。我们考虑了考虑两个门诊计划服务类型（Moud-Mecharone与咨询）的两种治疗结果（进展和完成）中的性别差异。接受美沙酮与咨询的客户有可能完成治疗计划的几率较低（或？= 0.366; 95％CI？= 0.163,0.821）。接受美沙酮的女性客户的取得进展的几率较低（或？= 0.668; 95％CI？= 0.481,0.929）并完成其治疗计划（或？= 0.666; 95％CI？=？0.485,0.916）与男性客户相比和接受咨询。与非拉丁客户相比，拉丁客户完成了完成治疗计划的几率（或？= 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高效的Moud，不太可能朝着或完成其治疗计划的进展而不是接受咨询。妇女，特别是那些被确定为拉丁裔的人，最不可能受益于基于美沙酮的计划。这些调查结果对健康政策和方案设计有影响，以考虑对基于美沙酮的计划中的全面和文化反应的服务，以改善妇女的门诊治疗结果。

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