Background. Methadone dosages exceeding 60 milligrams are linked with improved outcomes for injection drug users in many studies. High methadone doses have been endorsed by the Institute of Medicine and by other expert panels. Despite such findings, methadone maintenance fosters great ambivalence among many citizens, treatment providers, and drug users themselves. Anecdotal reports suggest that African-American providers may be especially reluctant to prescribe high methadone doses.
Methodology. Longitudinal data were examined from 124 treatment facilities in the 1988-95 National Drug Abuse Treatment System Survey. Low dosage was operationalized as the percentage of clients receiving less than 60 milligrams. A random-effects GLS estimator was used to control for facility effects. Statistical analysis was complemented by qualitative research exploring provider attitudes about appropriate methadone dose.
Results. Mean dosage increased over the study period. However, racial dosage disparities increased. Within the 1995 wave, low dosages were 9 percentage points more common in facilities with African-American directors (p=0.048) than in otherwise comparable facilities directed by non-Hispanic whites. Facilities serving African-American clients were also more likely to prescribe low doses. Within 1995 data, a 10 percentage point increase in African-American clients was associated with a 2 percent increase in the proportion of low-dose clients.(p=0.036)
Conclusion. The origin and implications of these racial disparities are unclear in these data. Current findings highlight the need for renewed dialogue regarding the benefits and costs of methadone treatment.
Learning Objectives: 1.Identify racial disparities in methadone policies. 2.Articulate cultural and medical issues in methadone treatment. cystic fibrosis."
Keywords: Methadone Maintenance, Ethnicity
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
The 128th Annual Meeting of APHA