George Washington University Trachtenberg School of Public Policy and Public Administration, Washington, District of Columbia, USA.
RAND Corporation, Arlington, Virginia, USA.
Subst Abus. 2022 Dec;43(1):1057-1071. doi: 10.1080/08897077.2022.2060424.
Buprenorphine is a key medication to treat opioid use disorder, but little is known about how treatment quality varies across sociodemographic groups. Objective: We examined measures of treatment quality and explored variation by sociodemographic factors. We used Medicaid MAX data from 50 states from 2006 to 2014 to identify buprenorphine treatment episodes ( = 317,494). We used multivariable logistic regression to examine the quality of buprenorphine treatment along four dimensions: (1) sufficient duration, (2) effective dosage, and concurrent prescribing of (3) opioid analgesics and (4) benzodiazepines. We explored how quality varied by race/ethnicity, age, sex, and urbanicity. In adjusted models, compared to non-Hispanic White individuals, non-Hispanic Black and Hispanic individuals had lower odds of receiving effective dosage (aORs = 0.79 and 0.89, respectively) and sufficient duration (aORs = 0.64 and 0.71, respectively), and lower odds of concurrent prescribing of opioid analgesics (aORs = 0.86 and 0.85, respectively) and benzodiazepines (aORs = 0.51 and 0.59, respectively). Older individuals had higher odds of sufficient duration (aORs from 1.21-1.33), but also had higher odds of concurrent opioid analgesics prescribing (aORs from 1.29-1.56) and benzodiazepines (aORs from 1.44-1.99). Females had higher odds of sufficient duration (aOR = 1.12), but lower odds of effective dosage (aOR = 0.77) and higher odds of concurrent prescribing of opioid analgesics (aOR = 1.25) and benzodiazepines (aOR = 1.16). Compared to individuals living in metropolitan areas, individuals living in non-metropolitan areas had higher odds of sufficient duration (aORs = 1.11 and 1.24) and effective dosage (aORs = 1.06 and 1.33), and lower odds of concurrent prescribing (aORs from 0.81-0.98). Black and Hispanic individuals were less likely to receive effective buprenorphine dosage and sufficient duration. Quality results were mixed for older and female individuals; although these individuals were more likely to receive treatment of sufficient duration, they were also more likely to be concurrently prescribed potentially contraindicated medications, and females were less likely to receive effective dosage. Findings raise concerns about adequacy of care for minority and other at-risk populations.
丁丙诺啡是治疗阿片类药物使用障碍的关键药物，但人们对不同社会人口群体的治疗质量差异知之甚少。目的：我们研究了治疗质量的衡量标准，并探讨了社会人口因素的变化。我们使用来自 2006 年至 2014 年 50 个州的医疗补助 MAX 数据来确定丁丙诺啡治疗病例（=317494）。我们使用多变量逻辑回归来检查丁丙诺啡治疗的四个方面的质量：（1）足够的持续时间，（2）有效剂量，以及同时开具（3）阿片类镇痛药和（4）苯二氮䓬类药物。我们探讨了质量如何因种族/民族、年龄、性别和城市程度而异。在调整后的模型中，与非西班牙裔白人相比，非西班牙裔黑人和西班牙裔人接受有效剂量的可能性较低（ORs=0.79 和 0.89）和足够的持续时间（ORs=0.64 和 0.71），同时接受阿片类镇痛药和苯二氮䓬类药物处方的可能性较低（ORs=0.86 和 0.85）。年龄较大的人获得足够持续时间的可能性更高（ORs 为 1.21-1.33），但同时接受阿片类镇痛药处方的可能性也更高（ORs 为 1.29-1.56）和苯二氮䓬类药物（ORs 为 1.44-1.99）。女性获得足够持续时间的可能性更高（OR=1.12），但有效剂量的可能性较低（OR=0.77），同时接受阿片类镇痛药处方的可能性更高（OR=1.25）和苯二氮䓬类药物（OR=1.16）。与居住在大都市区的人相比，居住在非大都市区的人获得足够持续时间（ORs=1.11 和 1.24）和有效剂量（ORs=1.06 和 1.33）的可能性更高，同时接受处方的可能性更低（ORs 为 0.81-0.98）。黑人和西班牙裔人接受有效丁丙诺啡剂量和足够持续时间的可能性较低。对于年龄较大和女性个体，质量结果参差不齐；尽管这些人更有可能接受足够的治疗，但他们也更有可能同时被开具潜在禁忌的药物，而女性接受有效剂量的可能性较低。研究结果引起了对少数民族和其他高危人群护理充分性的关注。
