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Amiri S, Panwala V, Amram O. Disparities in access to opioid treatment programs and buprenorphine providers by race and ethnicity in the contiguous U.S. J Subst Use Addict Treat 2024; 156:209193. [PMID: 37890620 DOI: 10.1016/j.josat.2023.209193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 07/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The burden of drug overdose mortality varies by race and ethnicity, with American Indian/Alaska Native (AI/AN), Black, and White people experiencing the largest burden. We analyzed census block group data to evaluate differences in travel distance to opioid treatment programs (OTP) and buprenorphine providers by race and ethnicity. METHODS The Substance Abuse and Mental Health Services Administration provided the addresses of OTPs and buprenorphine providers. The study classified block groups as majority (≥50 %) AI/AN, Black, Asian, White, no single racial majority, or Hispanic. We classified deprivation and rurality using the Area Deprivation Index and Rural-Urban Commuting Area codes. The study applied generalized linear mixed models. RESULTS Among all block groups, the median road distance to the nearest OTPs and buprenorphine providers was 8 and 2 miles, respectively. AI/AN-majority block groups had the longest median distances to OTPs (88 miles versus 4-10 miles) and buprenorphine providers (17 miles versus 1-3 miles) compared to other racial or ethnic majority block groups. For OTPs and buprenorphine providers, travel distances were slightly greater in more deprived block groups compared to less deprived block groups. The median distance to the nearest OTPs and buprenorphine providers were larger in micropolitan and small town/rural block groups compared to metropolitan areas. CONCLUSIONS Disparities exist in travel distance to OTPs and buprenorphine providers. People in block groups with AI/AN-majority, nonmetropolitan, or more deprived designation experience travel disparities accessing treatment. Future research should develop targeted interventions to reduce access to care disparities for individuals with opioid use disorder.
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Affiliation(s)
- Solmaz Amiri
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA.
| | - Victoria Panwala
- Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, USA
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Panwala V, Thorn E, Amiri S, Socias ME, Lutz R, Amram O. Opioid use and COVID-19: a secondary analysis of the impact of relaxation of methadone take-home dosing guidelines on use of illicit opioids. Am J Drug Alcohol Abuse 2023; 49:597-605. [PMID: 37433122 DOI: 10.1080/00952990.2023.2222336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023]
Abstract
Background: An exemption to existing U.S. regulation of methadone maintenance therapy after the onset of the COVID-19 pandemic permitted increased take-home doses beginning March 2020.Objectives: We assessed the impact of this exemption on opioid use.Methods: A pre/post study of 187 clients recruited from an OTP who completed a survey and consented to share their urine drug testing (UDT) data. Use of fentanyl, morphine, hydromorphone, codeine, and heroin was assessed via UDT. Receipt of take-home methadone doses was assessed from clinic records for 142 working days pre- and post-COVID exemption. Analysis was conducted using a linear regression model to assess the association between increased take-home doses and use of illicit opioids.Results: In the pre- vs. post-COVID-19 SAMHSA exemption periods, 26.2% vs. 36.3% of UDTs were positive for 6-acetylmorphine respectively, 32.6% vs. 40.6% positive for codeine, 34.2% vs 44.2% positive for hydromorphone, 39.5% vs. 48.1% positive for morphine, 8.0% vs. 14.4% positive for fentanyl (p-value < .001). However, in the unadjusted descriptive data, when grouped by change in substance use, those clients who experienced a decrease in the use of morphine, codeine, and heroin post-COVID-19 were given significantly more take-home doses than the groups that had no change or an increase in the use of these substances. In the adjusted model, there was no significant relationship between change in opioid use and increased receipt of take-home methadone doses.Conclusions: Although take-home doses post-COVID-19 nearly doubled, this increase was not associated with a significant change in use of illicit opioids.
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Affiliation(s)
- Victoria Panwala
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Emily Thorn
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Solmaz Amiri
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert Lutz
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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Panwala V, Joudrey P, Kowalski M, Bach P, Amram O. Changes to methadone maintenance therapy in the United States, Canada, and Australia during the COVID-19 pandemic: A narrative review. J Subst Use Addict Treat 2023; 152:209086. [PMID: 37270103 PMCID: PMC10232933 DOI: 10.1016/j.josat.2023.209086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/08/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION In response to the COVID-19 pandemic, countries across the world made adaptations to policies regulating the provision of methadone maintenance therapy (MMT) to facilitate social distancing for health care providers and people in treatment. Many countries issued guidance about increasing take-home methadone doses after the onset of the pandemic. METHODS In this review, we compare the regulation of MMT prior to the pandemic in the United States, Canada, and Australia, analyze changes to treatment policy in the context of COVID-19, and review emerging data on treatment outcomes. RESULTS The United States only permits the prescription and disbursement of methadone for MMT treatment at federally designated opioid treatment programs (OTPs). Conversely, Australia and Canada operate on a community pharmacy-based distribution model, where patients can access methadone doses either in participating pharmacies or in some methadone clinics. CONCLUSION Given reports of similar treatment outcomes and increased patient satisfaction since the pandemic-related policy changes, some changes including increased receipt of take-home doses should be considered for incorporation into post-pandemic treatment policies and regulations.
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Affiliation(s)
- Victoria Panwala
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
| | - Paul Joudrey
- Center for Research on Health Care, University of Pittsburgh, PA, USA
| | - Melanie Kowalski
- Mental Health and Wellbeing Division, Department of Health, Victoria, Australia
| | - Paxton Bach
- British Columbia Centre on Substance Use, University of British Columbia, Vancouver, BC, Canada
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
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Amram O, Amiri S, Panwala V, Lutz R, Joudrey PJ, Socias E. The impact of relaxation of methadone take-home protocols on treatment outcomes in the COVID-19 era. Am J Drug Alcohol Abuse 2021; 47:722-729. [PMID: 34670453 DOI: 10.1080/00952990.2021.1979991] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Background: In response to the COVID-19 pandemic, the US Substance Abuse and Mental Health Services Administration (SAMHSA) allowed for an increase in methadone take-home doses for the treatment of Opioid Use Disorder (OUD) in March 2020. OBJECTIVE To evaluate the effects of the SAMSHA exemption on methadone adherence and OUD-related outcomes. METHODS A convenience sample of 183 clients (58% female) were recruited from a methadone clinic in the fall of 2019 for a cross-sectional survey. Survey data was linked to clinical records, including urine drug testing (UDT) results for methadone and emergency department (ED) visits at the local hospital. Participants were on stable methadone dosing for 9 months prior to and following March 2020. Methadone adherence was assessed by UDTs; OUD-related outcomes were assessed by overdose events and ED visits. Logistic regression was used to assess the association between change in take-home methadone doses and outcomes. RESULTS Mean take-home doses increased nearly 200% (11.4 doses/30 days pre-COVID-19 vs. 22.3 post-SAMHSA exemption). ED visits dropped from 74 (40.4%) pre-COVID-19 to 56 (30.6%) post-SAMHSA exemption (p = <0.001). No significant changes were observed in either the number of clients experiencing overdose or those who experienced one or more methadone negative UDTs in the post-SAMHSA exemption period. Adjusted models did not show a significant association between changes in take-home doses and associated outcomes. CONCLUSIONS Despite a near-doubling of take-home methadone doses during the COVID-19 exemption period, the increase in take-home doses was not associated with negative treatment outcomes in methadone-adherent clients.
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Affiliation(s)
- Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.,Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Solmaz Amiri
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Victoria Panwala
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Robert Lutz
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.,Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Paul J Joudrey
- Yale Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eugenia Socias
- Faculty of Medicine, British Columbia Centre on Substance Use, University of British Columbia, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
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Ferlatte O, Panwala V, Rich AJ, Scheim AI, Blackwell E, Scott K, Salway T, Knight R. Identifying Health Differences Between Transgender and Cisgender Gay, Bisexual and Other Men Who Have Sex With Men Using a Community-Based Approach. J Sex Res 2020; 57:1005-1013. [PMID: 32186417 DOI: 10.1080/00224499.2020.1740148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this article, we describe a community-based research (CBR) approach to making a national online survey of gay, bisexual, and other men who have sex with men (GBMSM) inclusive of transgender GBMSM by working with members of the transgender community at all stages of the research process. This collaboration resulted in 209 transgender GBMSM completing our survey and we contrasted their health experiences with 7439 cisgender GBMSM. We found that transgender GBMSM were less likely than cisgender GBMSM to report intercourse without a condom (AOR 0.43; 95% CI: 0.28-0.66) and to have had an HIV test (AOR 0.64; 95% CI 0.49-0.85). Transgender GBMSM were more likely to report discrimination in the health care system in their lifetime (AOR 4.17; 95% CI 3.03-5.73), to self-rate their health as poor (AOR 3.47; 95% CI 2.52-4.80), and to have discussed depression (AOR 3.47; 95% CI 262-4.59) or anxiety (AOR 3.27; 95% CI 2.47-4.33) with a health care provider. Our experience highlights the feasibility of including transgender individuals in GBMSM research, while the results affirm the need for GBMSM health services to take into account the unique experiences of transgender GBMSM.
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Affiliation(s)
- Olivier Ferlatte
- Department of Social and Preventative Medicine, School of Public Health, University of Montreal
- Centre de Recherche en Santé Publique
- Community-Based Research Centre
| | | | - Ashleigh J Rich
- School of Population and Public Health, University of British Columbia
| | - Ayden I Scheim
- Department of Medicine, University of California San Diego
- Department of Epidemiology and Biostatistics, Drexel University
| | | | | | - Travis Salway
- Community-Based Research Centre
- Faculty of Health Sciences, Simon Fraser University
- British Columbia Centre for Disease Control
- Centre for Gender and Sexual Health Equity
| | - Rod Knight
- Community-Based Research Centre
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia
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