Gender disparities in opioid treatment progress in methadone versus counselling

The high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities in the United States necessitates a better knowledge of the factors that contribute to treatment success. While therapy and medication for OUD are considered the top standard of care in substance use disorder (SUD) treatment, many people with OUD receive just counseling or methadone-only therapies. This study compares gender inequalities in methadone-based treatment plan progress to counseling-based programs in one of the biggest SUD treatment systems in the United States.

The Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset was used to examine multi-year and multi-level (treatment program and client-level) data gathered in Los Angeles County, California. The sample was divided into four waves: 2011, 2012 (66 SUD programs, 1035 clients), 2013, 2014 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients).

Two multi-level negative binomial regressions were conducted, one for each outcome: (1) progress toward completion of treatment plan and (2) completion of treatment plan. Demographics, wave, homelessness, and past treatment episodes were controlled, as well as clients clustering within programs, and included outpatient clients released on each of the study's years (almost 95 percent of all clients).

Gender disparities in two treatment outcomes were detected when looking at two types of outpatient program services (MOUD-methadone vs. counselling). Clients who took methadone rather than psychotherapy had a decreased chance of finishing their treatment plan. Female methadone patients had a lower likelihood of making progress (OR = 0.668; % CI = 0.481, 0.929) and completing their treatment plan (OR = 0.666; % CI = 0.485, 0.916) than male patients undergoing counselling. When compared to non-Latina patients, Latina patients had a reduced likelihood of completing their treatment plan (OR = 0.617; % CI = 0.408, 0.934).

Patients who received methadone, the most frequent and highly successful MOUD in decreasing opiate use, were less likely than those who received counselling to make progress toward or finish their treatment goal. Women, particularly Latinas, were the least likely to benefit from methadone-based treatments. Generally, these outcomes may be explained by disparities in minority women's comprehensive service requirements (mental health therapy, child care services, etc.), program treatment methods (drug-free recovery or methadone maintenance), and quality of care (culturally and linguistically responsive care).

These findings highlight the importance for health policy and program design to to design evidence-based and culturally sensitive OUD treatment strategies that address the substantial obstacles that SUD programs confront in order to guarantee that women benefit equally from OUD therapy regardless of service delivery style.