Gender-specific predictors of methadone treatment outcomes among African Americans at an urban clinic

Abstract

Background: African American patients with opioid use disorder (OUD) have demonstrated poorer methadone maintenance treatment (MMT) outcomes compared with white patients. This issue is further complicated in urban settings, where African Americans experience high rates of poverty and publicly funded treatment. Despite interrelated factors that disadvantage African Americans, the literature focusing on this population is scant. To address this shortcoming, we conducted the first investigation of gender differences and gender-specific MMT outcome predictors among African Americans (or any racial minority population). This study provides gender-specific findings to improve African American MMT outcomes. Methods: We studied 211 African American patients (male: n = 137, 64.9%) at an urban, university-affiliated MMT clinic. We used existing intake data to assess baseline demographic, substance use, mental health, and interpersonal factors. Primary outcomes were 3-month drug⁺ (positive) urine drug screen (UDS) results and treatment retention. Results: Women were more likely (than men) to endorse histories of interpersonal violence, substance abuse in their social network, and mental health problems. Men reported a greater likelihood (than women) for early opioid-use onset and a lack of prior MMT. There were no gender differences in 3-month drug⁺ UDS or treatment retention. In multivariable analyses among women, no baseline factors predicted 3-month opioid⁺ UDS and physical abuse history predicted a higher proportion of 3-month cocaine⁺ UDS. Among men, primary injection opioid use and older age best predicted a higher proportion of 3-month cocaine⁺ UDS and parent substance abuse predicted shorter retention. In both gender-stratified analyses, higher proportions of 3-month opioid⁺ UDS and cocaine⁺ UDS predicted shorter retention. Conclusions: This study offers an analysis of gender differences in risk factors, MMT outcomes, and gender-specific predictors among African American patients. MMT clinics should tailor assessment and treatment protocols to address gender-specific needs.

Keywords:

• African American
• drug
• gender
• heroin
• medication-assisted treatment
• methadone
• minority health
• opioid use disorder
• sex
• urban

Acknowledgments

We thank Gary Rhodes for conducting the clinical intake interviews; Shami Entenman for early-stage electronic retrieval, coding, entry, and management of clinical data; and Michael Lisieski for compiling the initial data set.

Author contributions

J.J.L. wrote the manuscript and conducted analyses. S.B. helped to heighten translational value of study findings in our clinical implications and edited the manuscript. M.K.G. (clinical program director) supervised data aggregation, helped to conceptualize data, and edited the manuscript. D.M.L. provided supervision (to J.J.L.), helped to conceptualize data, and edited the manuscript.

Notes

i Ten patients (4.7% of the sample) were still in treatment (M = 1727 days, SD = 431) at the time data collection finished (May 2012).

ii Men with a history of suicidal attempt(s) were more likely to report prior mental health treatment (χ² = 15.44, P < .001); however, this was not the case for men with sexual abuse histories (χ² = 2.25, P = .134).