Black and Hispanic Opioid Users May Be Less Likely to Continue Treatment
New research says female opioid users have high odds of sticking with treatment, while black, Hispanic, and unemployed users are less likely to engage.
Researchers from the Boston University School of Medicine (BUSM) and the Boston University School of Public Health (BUSPH) tracked 1,200 patients who received buprenorphine treatment through Boston Medical Center’s Office Based Addiction Treatment program (OBAT) between 2002 and 2014.
They found that the patients with the greatest odds of continued treatment were older-age and female opioid users, as well as those with a coexisting psychiatric condition. Black, Hispanic, and unemployed individuals, as well as those with hepatitis C, had the lowest odds of long-term adoption.
“It begs the question of, what are some systemic barriers or facilitators that we are creating, intentionally or unintentionally, to make it easier for patients to stay in this life-saving treatment?” asks lead author Zoe Weinstein, director of the Addict Consult Service at BMC and an assistant professor at BUSM.
Unfortunately, Weinstein’s study doesn’t answer that question just yet—she says more research is necessary before we can answer the why as well as the what. Still, she says social factors are probably at play.
“Are patients who are black or Hispanic more likely to be leaving the clinic because of criminal justice involvement, or were they more likely to leave the clinic because of administrative discharge—are we being more punitive with those patients?” she asks. “There could be patterns like that…or even implicit bias or differential treatment from providers.” (This study didn’t show statistically significant evidence of those effects, but Weinstein says it’s possible they exist outside its relatively small sample size.)
As for why women seem to be more engaged with treatment, Weinstein guesses it’s related to the difficulties they face simply entering care. If a woman is able to navigate certain obstacles related to seeking treatment, such as childcare and fear of governmental intervention, she may be more likely to follow the program once she’s in it. Past research has also shown that women tend to be more medically compliant in general, she says.
Results like these, Weinstein says, show how necessary it is to keep investigating the various factors that affect substance abuse treatment.
“Social determinants of health are quite important and play a large role,” she says. “It’s also imperative for us, as providers, to look at if there is bias in our treatment systems that perhaps we are perpetuating.”