Buprenorphine and methadone treatment for opioid dependence by income, ethnicity and race of neighborhoods in New York City

Abstract

Background Geographic and demographic variation in buprenorphine and methadone treatment use in U.S. cities has not been assessed. Identifying variance in opioid maintenance is essential to improving treatment access and equity. Purpose To examine the differential uptake of buprenorphine treatment in comparison to methadone treatment between 2004 and 2013 in neighborhoods in New York City characterized by income, race and ethnicity. Methods Social area (SA) analysis of residential zip codes of methadone and buprenorphine patients in NYC, which aggregated zip codes into five social areas with similar percentages of residents below poverty, identifying as Black non-Hispanic and as Hispanic, to examine whether treatment rates differed significantly among social areas over time. For each rate, mixed model analyses of variance were run with fixed effects for social area, year and the interaction of social area by year. Results Buprenorphine treatment increased in all social areas over time with a significantly higher rate of increase in the social area with the highest income and the lowest percentage of Black, Hispanic, and low-income residents. Methadone treatment decreased slightly in all social areas until 2011 and then increased bringing rates back to 2004 levels. Treatment patterns varied by social area. Conclusions Buprenorphine treatment rates are increasing in all social areas, with slower uptake in moderate income mixed ethnicity areas. Methadone rates have remained stable over time. Targeted investments to promote public sector buprenorphine prescription may be necessary to reduce disparities in buprenorphine treatment and to realize its potential as a public health measure.

Trends and mental health correlates of nonmedical opioid use among criminal justice-involved African American men

“…Cognitive behavioral therapy (Kumari et al, 2016; Moore et al, 2016) and contingency management (Ling et al, 2013) have previously shown effectiveness with community-based samples and may have potential – if culturally adapted to address the specific substance use and mental health needs of criminal justice-involved African American men. Finally, while medication-based interventions have shown some efficacy (Carroll & Weiss, 2017) and effectiveness (Damian et al, 2017), compared to Whites, African Americans are disproportionately underrepresented in pharmacotherapy studies (Hansen et al, 2016; Mitchell et al, 2016). More research is needed to assess the acute and long-term effectiveness of buprenorphine, methadone, and potential barriers in accessing related treatments among African American men re-entering the community from prison.…”

Re‐racialization of Addiction and the Redistribution of Blame in the White Opioid Epidemic

“…It has responded to opioid overdose pharmaceutically: The buprenorphine/Suboxone prescription rate is higher on Staten Island than in any other borough (Hansen et al. ). Residents of the higher income South Shore neighborhoods fill out 69% of all buprenorphine prescriptions on the island (New York State Department of City Planning ).…”

At the Expense of a Life: Race, Class, and the Meaning of Buprenorphine in Pharmaceuticalized “Care”

“…Most buprenorphine patients are treated in private physician practices (Roman, Ducharme, & Knudsen, 2006; Fiellin, 2007; Barry et al, 2010; Stanton et al, 2006; Magura et al, 2007) and pay out-of-pocket (Kissin, McLeod, Sonnefeld, & Staton, 2006) or are privately insured (Andrews, D’Aunno, Pollack, & Friedmann, 2014). Studies mapping buprenorphine prescriptions in New York City, the U.S. city with the largest opiate dependent population, confirm higher prescription rates in high-income residential areas with low percentages of Black and Latino/a residents (Hansen et al, 2013; Hansen et al, 2016). …”