Emerging evidence suggests that gender disparities exist in both access to and retention in methadone treatment programs in low income communities. This multiyear cross-sectional study published in the Journal of Substance Abuse Treatment also found that women who identified as African American, Latino, or Other (racial and ethnic groups) were more likely to experience shorter treatment duration than women who identified as non-Latino White, or clients who were men.
The opioid epidemic has had a profound effect on racial and ethnic minority communities across the United States. Disproportionate rates of mental illness, homelessness, and severity of substance use, as well as client-provider interactions that lack cultural competency have led to significant barriers in access to treatment that are largely shaped by structural racism.
Investigators collected client and program level data from the Los Angeles County Participant Reporting System (LACPRS) and the Integrated Substance Abuse Treatment to Eliminate Disparities survey in 2011, 2013, 2015, and 2017 from 34 publicly funded outpatient treatment programs in Los Angeles County, California. Clients with opioid use disorders were identified by the selection of heroin or opioid analgesics as their primary or secondary drug on the client intake form. Almost all clients (99%) in these programs were given methadone as treatment.
Counselors at intake collected self-reported information on client demographics, education level, employment, psychosocial characteristics, housing status, and drug use. Access was defined as the number of days that clients were on the waiting list before admission into a treatment program, and retention was measured by the number of days clients remained in treatment. These metrics were gathered by counselors as part of the intake and discharge process.
Investigators compared the incidence rates of access and retention for women and men using negative binomial models and found that women spent more days waiting to enter outpatient methadone treatment than men, but remained in the treatment longer than men (incident rate ratio (IRR)=1.795; P <.091). Clients in low income, urban neighborhoods waited longer to gain access to culturally competent treatment programs (IRR=1.135; P <.066). Clients who identified as African American compared with Whites spent more time on a waitlist (IRR=1.761), while clients identifying as Latino and Other (ie, clients who did not identify as White, African American, or Latino) were likely to spend less time on a waitlist (IRR=0.628 and IRR=0.209, respectively).
When examining the interaction of race and ethnicity by gender, investigators found that only women who identified as Other were more likely to experience longer wait times compared with those who identified as White men (IRR=5.956; P <.067). Women were less likely to be employed, but more likely to report a diagnosis of mental illness than men. Moreover, women reported use of their primary drug at an older age than men.
Study limitations included a lack of generalizability to other populations because of the centralization to Los Angeles County as well as the LACPRS data being largely self-reported. Clients who have had multiple treatment episodes and longer treatment times might also be represented in more than one wave of data collection.
“Overall, findings call for improving treatment access and retention for women with OUD, who served in outpatient methadone treatment programs through comprehensive, gender-specific, and evidence based programming,” researchers concluded.
Marsh J, Amaro H, Kong Y, Khachikian T, Guerrero. Gender disparities in access and retention in outpatient methadone treatment for opioid use disorder in low-income urban communities. J Subst Abuse Treat. Published online April 11, 2021.doi:10.1016/j.jsat.2021.108399