A Precise Investigation of African-American Women in Methadone Treatment: Gender Differences and Predictors of Early-Treatment Drug Use

Background and Purpose. African American patients with opioid use disorder have demonstrated heightened risk for worse methadone-maintenance-treatment [MMT] outcomes. Less attention has been paid to MMT outcomes specific to African-American women. Prior investigations have typically examined gender to predict treatment outcomes (without subsample analyses) or relied on gender-stratified analyses with heterogeneous race/ethnic samples. This study aims to fill a gap in the literature regarding characteristics and MMT outcomes specific to African-American women. Within a larger sample of African-American MMT patients, we examined gender differences in (1) baseline characteristics and (2) MMT outcomes. We also identified (3) the baseline characteristics uniquely associated with female gender and (4) which baseline characteristics best predicted short-term MMT outcomes among African-American females.   

Methods. The sample consisted of 212 African-American patients (female: n = 74, 34.9%), typically in their early 50’s (M = 52.0), unemployed or outside the labor force (n = 205, 96.7%), and on publicly funded treatment (n = 206, 97.2%) at an urban, university-affiliated MMT clinic. Existing intake data (2004-2009) was used to measure baseline clinical (e.g., age of opioid-use onset, prior MMT, co-occurring cocaine use disorder), psychosocial (e.g., interpersonal abuse, peer network substance abuse, mental health problems), and demographic (e.g., age, education, has children) characteristics. We assessed short-term treatment outcomes using the proportion of opioid⁺ and cocaine⁺ urine drug screens [UDS] during the first three months of MMT. Data analyses included chi-square and t-tests to examine gender differences among categorical and continuous variables. We conducted two separate sets of multivariate analyses to identify the baseline characteristics uniquely associated with female gender, and the predictive contribution of baseline characteristics to short-term MMT outcomes among the African-American female subsample.

Results. African-American women were more likely to report later opioid-use onset (age 21 or older) (p < .001), histories of interpersonal abuse (p < .001), depression (p < .01), anxiety/tension (p < .05), and peer network substance abuse (p < .05), and were more likely to report prior MMT and have children (ps < .05). With regard to short-term MMT outcomes, women (non-significantly) provided a higher proportion of opioid⁺ (p < .10) and cocaine⁺ UDS (p < .15). In multivariate analyses explaining African-American female status, a late opioid-use onset (OR: 6.85, p < .001) and a history of interpersonal abuse (OR: 4.11, p < .001), best characterized female (compared to male) patients. Within the African-American female subsample, histories of interpersonal abuse and peer network substance abuse (ps < .05) both predicted a higher proportion of cocaine⁺ UDS, though these relationships were non-significant when including baseline co-occurring cocaine use disorder (p < .001) in the model. There were no significant predictors explaining the proportion of opioid⁺UDS.

Conclusions and Implications. This study provides a focused analysis and substantive contribution to gender differences and MMT outcomes among a sample of African-Americans with opioid use disorder. Our findings provide a precise understanding of influential characteristics to short-term MMT outcomes among African-American women. Continued research and cohort-specific intervention development is warranted to increase translational impacts for African-American women.