METHODS: This was a retrospective analysis of state discharge data from the 2006-2016 Treatment Episode Data-Discharge. Data were included representing discharges from OAT programs. Clients with discharge records who reported their primary drug as heroin or other opioids were included in the analysis (N=4,235,611). We conducted our analyses in a series of steps. First, we examined the main effects of gender on discharge disposition. Next, we included two-way interaction terms to examine whether changes in OAT and successful completion vary over time and by opioid type between men and women. Finally, we conducted logistic regression models of OAT and successful completion separately by gender to explore gender-specific effects. All data analyses were conducted in Stata/MP version 15.
RESULTS: Approximately 28.5% of women and 27.2% of men received OAT across the study period. The rate of OAT significantly decreased over time for men compared to women, a trend that remained consistent in the multivariate models. Compared to women, men were significantly less likely to receive OAT in the multivariate models. Among patients receiving OAT, the relationship between gender and treatment completion varied significantly by type of opioid use disorder (heroin vs other opiates).
CONCLUSION AND IMPLICATIONS: Disparities in receipt of OAT and treatment completion persisted between women and men in the multivariate models. OAT receipt of treatment is low overall and appears to be declining, especially among men. Women are less likely than men to complete treatment successfully, a trend that is decreasing overtime. More research is needed to understand gender-specific barriers in treatment to address disparities and increase access to and the success of evidence-based treatment. Future research should consider the role of organizational and system factors in understanding gender disparities OAT utilization and completion rates.