Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration

Jan 26, 2016Drug and alcohol dependence

Differences in Veterans Using Buprenorphine or Methadone for Opioid Treatment in the Veterans Health System

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Abstract

A ten-year increase in age is associated with a 33% lower odds of receiving buprenorphine compared to methadone.

Urban residence is linked to a 74% lower odds of receiving buprenorphine compared to methadone.
Black race is associated with a 61% lower odds of receiving buprenorphine compared to methadone.
Medical and psychiatric comorbidities do not show substantial differences between veterans receiving buprenorphine and those receiving methadone.
Demographic characteristics appear to be the primary factors influencing the choice of opioid agonist therapy among veterans.

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BACKGROUND: The advent of buprenorphine as an alternative to methadone has dramatically shifted the landscape of opioid agonist therapy (OAT) for opioid use disorder (OUD). However, there is limited US national level data describing thedifferences between patients who are prescribed these two OAT options.

METHODS: From veterans with OUD diagnosis who used Veterans Health Administration services in 2012, we identified 3 mutually exclusive groups: those who received (1) buprenorphine only (n=5,670); (2) methadone only (n=6,252); or (3) both buprenorphine and methadone in the same year (n=2513). We calculated the bi-varate effect size differences (risk ratios and Cohen's d) forcharacteristics that differentiated these groups. Logistic regression analysis was then used to identify factors independently differentiating the groups.

RESULTS: Ten year increment in age (OR 0.67; 95% CI 0.64-0.70), urban residence (OR 0.26; 95% CI 0.25-0.33), and black race (OR 0.39; 95% CI 0.35-0.43) were strongly and negatively associated with odds of receiving buprenorphine compared to methadone, while medical and psychiatric comorbidities or receipt of other psychiatric medications did not demonstrate substantial differences between groups.

CONCLUSIONS: Differences between veterans receiving buprenorphine or methadone based OAT seems to be largely shaped by demographic characteristics rather than medical or psychiatric or service use characteristics. A clearer understanding of the reasons for racial differences could be helpful in assuring that black OUD patients are not denied the opportunity to receive buprenorphine if that is their preference.

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Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration

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