Variation in Use of Buprenorphine and Methadone Treatment by Racial, Ethnic, and Income Characteristics of Residential Social Areas in New York City

Abstract

National data indicate that patients treated with buprenorphine for opiate use disorders are more likely to be White, highly educated, and to have greater incomes than those receiving methadone, but patterns of buprenorphine dissemination across demographic areas have not been documented in major metropolitan areas where poverty, minority populations and injection heroin use are concentrated. Rates of buprenorphine and methadone treatment are compared among areas of New York City defined by their income and ethnic/racial composition. Residential social areas (hereinafter called social areas) were defined as aggregations of ZIP codes with similar race/ethnicity and income characteristics, and were formed based on clustering techniques. Treatment rates were obtained for each New York City ZIP code: buprenorphine treatment rates were based on the annual number of buprenorphine prescriptions written, and the methadone treatment rate on the number of methadone clinic visits for persons in each ZIP code. Treatment rates were correlated univariately with ethnicity and income characteristics of ZIP codes. Social area treatment rates were compared using individual ANOVA models for each rate. Buprenorphine and methadone treatment rates were significantly correlated with the ethnicity and income characteristics of ZIP codes, and treatment rates differed significantly across the social areas. Buprenorphine treatment rates were highest in the social area with the highest income and lowest percentage of Black and Hispanic residents. Conversely, the methadone treatment rate was highest in the social area with the highest percentage of low income and Hispanic residents. The uneven dissemination of 0pioid maintenance treatment in New York City may be reflective of the limited public health impact of buprenorphine in ethnic minority and low income areas. Specific policy and educational interventions to providers are needed to promote the use of buprenorphine for opiate use disorders in diverse populations.

Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration

“…Additional differences in clinical, psycho-patholological and sociodemographic characteristics, as well co-morbid medical and psychiatric diagnoses, use of concomitant psychotropic medications, and healthcare service use between these two groups have been noted in previous studies (Barnett, 2009; Baxter et al, 2011; Fingerhood et al, 2014; Gerra et al, 2004; Hansen et al, 2013; Maremmani et al, 2011, 2007; Oliva et al, 2012, 2013; Proctor et al, 2014; Stein et al, 2012). However, a detailed national level comparative study of the characteristics of patients who receive each of these treatments has yet to be published despite the dramatic change in the nature of OAT utilization in the United States during the past decade.…”

“…Despite prior studies showing that use of mental health services among blacks in VHA is generally similar or greater to that of whites (Gamache et al, 2000; Greenberg and Rosenheck, 2003), in this study of OAT, the low utilization of buprenorphine compared to methadone among blacks persisted even after controlling for income, age and rural location. This racial difference in utilization of OAT options may reflect differences in availability at more localized neighborhood levels (Hansen et al, 2013). …”

White opioids: Pharmaceutical race and the war on drugs that wasn’t

“…To the present day, methadone is restricted to specialized clinics with strict DEA oversight, directly observed dosing and frequent urine toxicology screens. Methadone clinics are typically concentrated in African American and Latino communities (Hansen and Roberts, 2012; Hansen et al , 2013). In 2000, the Drug Addiction Treatment Act (DATA) was passed and allowed any certified physician to prescribe an opioid – Suboxone ® – in the privacy of their own offices to treat addiction.…”

The War on Drugs That Wasn’t: Wasted Whiteness, “Dirty Doctors,” and Race in Media Coverage of Prescription Opioid Misuse

“…Indeed, not only are black and brown people who use drugs more likely to be incarcerated than white drug users, they are also less likely to be seen by healthcare providers and offered addiction treatment, counseling or tools for prevention of overdose and injection related infections (Acevedo et al 2015). If they do receive medical treatment for opioid dependence, they are more likely than their white counterparts to receive methadone, under DEA surveillance in stigmatized methadone clinics, than to receive buprenorphine, which is pharmacologically similar to methadone but can be prescribed in the privacy of a doctor's office and taken at home (Hansen and Roberts 2012; Hansen et al 2013). …”