Gender Disparities in Opioid Treatment Progress Based on Counseling Versus Methadone

Background: In the United States, the high dropout rate (>75% in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress towards treatment goals. Whereas counseling and medication for OUD (MOUD, e.g. methadone, buprenorphine, naltrexone) is considered the gold standard of care in substance use disorder (SUD) treatment, many individuals with OUD receive either counseling or methadone only services. This study evaluates gender disparities in treatment plan progress in either methadone or counseling in one of the largest SUD treatment systems in the United States.

Methods: Multi-year and multi-level (treatment program and client-level) data were analyzed using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset collected in Los Angeles County, California. The sample consisted of 4 waves: 2011 (66 SUD programs, 1035 clients), 2013 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients). We conducted two multi-level negative binomial regressions, one per each outcome (1) making progress towards completing treatment plan, and (2) successfully completing treatment plan. We accounted for clients clustered within programs.

Results: Findings demonstrated gender differences in treatment outcome (progress vs. completion) considering two outpatient treatment types (MOUD-methadone vs counseling). Clients who received counseling vs methadone were more likely to either make progress toward or complete their treatment plan. Clients receiving methadone had lower odds of completing their treatment plan compared to those receiving counseling only (OR = 0.366; 95% CI = 0.163, 0.821). Female clients receiving methadone had lower odds of both completing their treatment plan (OR = 0.666; 95% CI = 0.485, 0.916), and making progress (OR = 0.668; 95% CI = 0.481, 0.929) compared to male clients and those receiving counseling only. Latina clients had lower odds of completing their treatment plan (OR = 0.617; 95% CI = 0.408, 0.934) compared with non-Latino White males.

Conclusions: Clients receiving methadone, the most common and highly effective MOUD in reducing opioid use, were less likely to achieve progress towards or complete their treatment plan than those receiving counseling. Women, and in particular those identified as Latinas, were the clients least likely to benefit from OUD treatment. Findings have implications for health policy and program design that consider the intersectionality of gender and race/ethnicity in promoting positive treatment outcomes.