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3 Treatment with Medications for Opioid Use Disorder in Different Populations
Pages 63-90

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From page 63...
... 3 Treatment with Medications for Opioid Use Disorder in Different Populations Most people who could benefit from medicationbased treatment for opioid use disorder do not receive it, and access is inequitable across subgroups of the population.
From page 64...
... This chapter examines the evidence about the provision of OUD medications within the United States to different populations, including children and adolescents; older persons; different sexes and genders; pregnant women; sexual minorities; individuals with comorbidities; racial and ethnic minorities; people of low socioeconomic status; and rural and urban populations. However, more and better data are needed to track the rates of people with OUD receiving medication nationally and within subsets of the population (see Box 3-1)
From page 65...
... Given the developmental changes that people undergo during adolescence, treatment strategies designed for adults may not be appropriate for those who are not yet 18 (Center for Substance Abuse Treatment, 2006)
From page 66...
... . A retrospective review of long-term treatment outcomes for buprenorphine– ­ naloxone treatment among adolescents with OUD found that treatment retention helps to promote long-term remission (Matson et al., 2014)
From page 67...
... However, treatment outcomes for older adults are often equivalent to or better than treatment outcomes among younger people (Clay, 2010)
From page 68...
... . An r analysis of a nationally representative survey of drug treatment programs found that in methadone treatment programs, an increasing proportion of female patients was associated with a lower proportion of patients in treatment for longer than 1 year (Frimpong et al., 2017)
From page 69...
... . Pregnant women with untreated OUD are up to six times more likely than other women to have maternal complications, including low birthweight and fetal distress, while neonatal complications among babies born to mothers with OUD range from neonatal abstinence syndrome and neurobehavioral problems to a 74-fold increase in sudden infant death syndrome (Minozzi et al., 2013)
From page 70...
... . A comparison of OUD treatments for pregnant women across seven studies found no significant differences in maternal outcomes, neonatal outcomes, or serious adverse outcomes for buprenorphine–naloxone compared with buprenorphine alone, methadone maintenance, or methadone-assisted withdrawal (Lund et al., 2013)
From page 71...
... For sexual minority populations with OUD, for example, treatment programs could be delivered through a traumainformed approach to care that integrates primary care with behavioral health and specifically addresses the stressors experienced by sexual minorities (Girouard et al., 2019)
From page 72...
... . Co-occurring mental health disorders appear to be more commonly diagnosed among women than men; they are also more commonly diagnosed among people engaged in the criminal justice system than the general population (Center for Substance Abuse Treatment, 2006; Mbaba et al., 2018)
From page 73...
... . Failing to address tobacco use can negatively affect OUD treatment, and the OUD treatment process provides an opportunity to provide smoking cessation treatment (Mannelli et al., 2013)
From page 74...
... . Populations with Chronic Pain Both chronic pain and addiction are conditions driven by neurophysiological processes and shaped by a confluence of genetic and environmental factors (Center for Substance Abuse Treatment, 2012)
From page 75...
... . Co-location of HIV and OUD treatment in primary care or OTPs has been demonstrated to improve treatment outcomes for both conditions (Berg et al., 2011; Low et al., 2016; Lucas et al., 2010)
From page 76...
... , but existing data regarding how minority populations access medication-based treatment compared with whites are mixed. One study of racial and ethnic differences in the receipt of medication for OUD found that while less than 30 percent of all patients received medication, the odds of receiving it were significantly higher among African American and Hispanic patients who used heroin than among white people who used heroin, which could not be explained by differences in clinical need (Krawczyk et al., 2017a)
From page 77...
... . Whether an individual with OUD is transient, recently displaced, or chronically homeless, it can negatively ­ ffect treatment outcomes (Center for Substance Abuse Treatment, 2006)
From page 78...
... . Proactive case management may help to coordinate social services to provide home ­ less patients with food, shelter, and transportation to treatment (­ enter for C Substance Abuse Treatment, 2006)
From page 79...
... . One way to address the workforce shortage is to incentivize health care providers to provide OUD treatment in underserved areas (e.g., via loan repayment programs, such as the Health Resources and Services Administration's National Health Service Corps)
From page 80...
... 2015. Sex differences in substance use, health, and social functioning among opioid users receiving methadone treatment: A multicenter cohort study.
From page 81...
... 2012. Epidemiology of pain among outpatients in methadone maintenance treatment programs.
From page 82...
... 2011. Drug treatment outcomes among HIV-infected opioid-dependent patients receiving buprenorphine/naloxone.
From page 83...
... 2004. Opioid-, cannabis- and alcohol-dependent women show more rapid progression to substance abuse treatment.
From page 84...
... 2016. Distribution of substance abuse treatment facilities across the rural–urban continuum.
From page 85...
... 2000. Increasing access and providing s ­ocial services to improve drug abuse treatment for women with children.
From page 86...
... 2011. Use of the evidence base in substance abuse treatment programs for American Indians and Alaska Natives: Pursuing quality in the crucible of practice and policy.
From page 87...
... 2003. Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities.
From page 88...
... 2017. Volatility and change in chronic pain severity predict outcomes of treatment for prescription opioid addiction.
From page 89...
... 2010. Route of administration for illicit prescription opioids: A comparison of rural and urban drug users.


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