Highlights
- Limited knowledge about agonist treatment choice for opioid use disorder in practice.
- Compared characteristics of veterans on buprenorphine vs methadone nationally.
- The choice was shaped by demographic characteristics rather than clinical factors.
- We also found significant race based variations in choice of agonist therapy.
The
advent of buprenorphine as an alternative to methadone has dramatically shifted
the landscape of opioid agonist therapy (OAT) for opioid use disorder (OUD).
However, there is limited US national level data describing thedifferences
between patients who are prescribed these two OAT options.
Methods
From
veterans with OUD diagnosis who used Veterans Health Administration services in
2012, we identified 3 mutually exclusive groups: those who received (1)
buprenorphine only (n = 5,670); (2) methadone only (n = 6,252);
or (3) both buprenorphine and methadone in the same year (n = 2513).
We calculated the bi-varate effect size differences (risk ratios and Cohen’s d)
forcharacteristics that differentiated these groups. Logistic regression
analysis was then used to identify factors independently differentiating the
groups.
Results
Ten
year increment in age (OR 0.67; 95% CI 0.64–0.70), urban residence (OR 0.26;
95% CI 0.25–0.33), and black race (OR 0.39; 95% CI 0.35–0.43) were strongly and
negatively associated with odds of receiving buprenorphine compared to
methadone, while medical and psychiatric comorbidities or receipt of other
psychiatric medications did not demonstrate substantial differences between
groups.
Conclusions
Differences
between veterans receiving buprenorphine or methadone based OAT seems to be
largely shaped by demographic characteristics rather than medical or
psychiatric or service use characteristics. A clearer understanding of the
reasons for racial differences could be helpful in assuring that black OUD
patients are not denied the opportunity to receive buprenorphine if that is
their preference.
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Affiliations
Department of Internal Medicine, Yale School of Medicine,
New Haven, CT, United States
VA New England Mental Illness Research and Education Center,
West Haven, CT, United States
Department of Psychiatry, Yale School of Medicine, New
Haven, CT, United States
Correspondence
Corresponding author at: VA Interprofessional Fellow in
Addiction Treatment, VACT Healthcare System, Bldg. 12A, 950 Campbell Avenue,
West Haven, CT 06516, United States.
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