Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, United States of America.
University of Arkansas for Medical Sciences College of Public Health, Little Rock, Arkansas, United States of America.
PLoS One. 2020 Feb 6;15(2):e0228755. doi: 10.1371/journal.pone.0228755. eCollection 2020.
Disparities in methadone maintenance therapy (MMT) outcomes have received limited attention, but there are important negative outcomes associated with MMT that warrant investigation. Racial discrimination is common in healthcare settings and affects opioid use disorder (OUD) treatment and comorbidities. However, race/ethnicity alone may not fully explain experiences of discrimination. MMT remains highly stigmatized and may compound the effect of race/ethnicity on discrimination in healthcare settings. We sought to quantify differential associations between MMT and experiences of racial discrimination between racial/ethnic groups in a U.S. national sample.
We used the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013) to identify a subset of individuals with a lifetime OUD who had ever used MMT (survey n = 766; weighted population n = 5,276,507). We used multivariable logistic regression to model past-year experience of racial discrimination in a healthcare setting. We included an interaction term between race/ethnicity and MMT status to identify the odds of discrimination (MMT vs. no MMT [referent]) within racial/ethnic groups. We used survey procedures with weights to account for the parent study's complex survey design.
Twenty-two percent of our sample experienced racial discrimination in a healthcare setting in the past year. Discrimination was more common among those who had ever used MMT (x2 = 10.00, p = 0.001) and racial/ethnic minorities (x2 = 23.15, p<0.001). The interaction effect was much stronger than the main effects of race/ethnicity and MMT status. MMT status (versus no MMT) was positively associated with discrimination among Blacks (aOR = 3.93, 95% CI = 3.87-3.98, p<0.001), Whites (aOR = 2.25, 95% CI = 2.23-2.27, p<0.001), and Latino/Latinas (aOR = 1.59, 95% CI = 1.55-1.62, p<0.001). Among American Indian/Alaska Natives (AI/AN), those who had used MMT had over thirty times the odds of racial discrimination, compared to their non-MMT counterparts (aOR = 32.78, 95% CI = 31.16-34.48, p<0.001).
Race/ethnicity alone did not sufficiently account for racial discrimination in healthcare settings among those with a lifetime OUD. MMT status was strongly associated with racial discrimination among AI/AN. Our strong interaction effect is indicative of an additional barrier to health services utilization among AI/AN, which has important implications for OUD treatment outcomes and comorbidities. Health promotion programs aimed at increased adoption of MMT are promising, but should be considered in the context of racial/ethnic disparities, drug use and MMT stigma, and implicit biases in clinical settings.
美沙酮维持治疗（MMT）的结果存在差异，但与 MMT 相关的重要负面结果值得研究。在医疗保健环境中，种族歧视很常见，会影响阿片类药物使用障碍（OUD）的治疗和合并症。然而，种族/民族可能无法完全解释歧视经历。MMT 仍然受到高度污名化的影响，可能会加剧种族/民族对医疗保健环境中歧视的影响。我们旨在量化美国全国样本中，种族/民族群体之间 MMT 与种族歧视经历之间的差异关联。
我们使用全国酒精和相关条件调查-III（2012-2013 年）来确定有终生 OUD 且曾使用 MMT 的个体子集（调查 n = 766；加权人口 n = 5276507）。我们使用多变量逻辑回归模型来模拟过去一年在医疗保健环境中经历种族歧视的情况。我们在种族/民族之间包含了一个 MMT 状态与种族/民族之间的交互项，以确定在特定种族/民族群体中，歧视的可能性（MMT 与无 MMT[参考]）。我们使用调查程序和权重来考虑父母研究的复杂调查设计。
我们样本中的 22%在过去一年中在医疗保健环境中经历过种族歧视。曾经使用过 MMT 的人（x2 = 10.00，p = 0.001）和少数族裔（x2 = 23.15，p<0.001）中歧视更为常见。交互效应远强于种族/民族和 MMT 状态的主要效应。与未使用 MMT 相比，使用 MMT（MMT 状态）与黑人（优势比[OR] = 3.93，95%置信区间[CI] = 3.87-3.98，p<0.001）、白人（OR = 2.25，95% CI = 2.23-2.27，p<0.001）和拉丁裔/拉丁裔（OR = 1.59，95% CI = 1.55-1.62，p<0.001）之间存在正相关。在美洲印第安人/阿拉斯加原住民（AI/AN）中，与未使用 MMT 的人相比，使用 MMT 的人经历种族歧视的可能性高出三十多倍（OR = 32.78，95% CI = 31.16-34.48，p<0.001）。
种族/民族并不能充分解释有终生 OUD 的人在医疗保健环境中经历的种族歧视。MMT 状态与 AI/AN 中的种族歧视密切相关。我们的强交互效应表明，AI/AN 群体在获得医疗服务方面存在额外的障碍，这对 OUD 治疗结果和合并症具有重要意义。旨在增加 MMT 采用的健康促进计划很有前景，但应考虑到种族/民族差异、药物使用和 MMT 污名化以及临床环境中的隐性偏见。
