School of Social Work, Wayne State University , Detroit , Michigan , USA.
Substance Abuse Research Division, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine , Detroit , Michigan , USA.
Subst Abus. 2019;40(2):185-193. doi: 10.1080/08897077.2018.1547810. Epub 2019 Mar 19.
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. We studied 211 African American patients (male: = 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. 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. 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.
非裔美国阿片类药物使用障碍（OUD）患者的美沙酮维持治疗（MMT）结果比白人患者差。在城市环境中，这个问题更加复杂，非裔美国人经历着高贫困率和公共资金治疗。尽管存在使非裔美国人处于不利地位的相关因素，但针对这一人群的文献却很少。为了解决这一不足，我们首次对非裔美国人（或任何少数族裔人口）中的性别差异和特定于性别的 MMT 结果预测因素进行了调查。这项研究提供了特定于性别的发现，以改善非裔美国人的 MMT 结果。
我们研究了 211 名在城市大学附属 MMT 诊所的非裔美国患者（男性：=137，64.9%）。我们使用现有的入组数据评估基线人口统计学、药物使用、心理健康和人际关系因素。主要结局是 3 个月的药物（阳性）尿液药物检测（UDS）结果和治疗保留率。
女性比男性更有可能（比男性）有过人际暴力、社交网络中的药物滥用和心理健康问题的病史。男性报告说，他们更有可能（比女性）早期开始使用阿片类药物，而且没有接受过之前的 MMT。3 个月的药物 UDS 或治疗保留率在性别之间没有差异。在女性的多变量分析中，没有基线因素预测 3 个月的阿片类药物 UDS，而身体虐待史预测了更高比例的 3 个月可卡因 UDS。在男性中，主要的注射阿片类药物使用和年龄较大预测了更高比例的 3 个月可卡因 UDS，而父母的药物滥用预测了较短的保留时间。在这两种性别分层分析中，较高比例的 3 个月阿片类药物 UDS 和可卡因 UDS 预测了较短的保留时间。
这项研究提供了对非裔美国患者中风险因素、MMT 结果和特定于性别的预测因素的性别差异分析。MMT 诊所应根据性别需求调整评估和治疗方案。
