Abstract

Question The opioid epidemic causes massive morbidity, and males have substantially greater overdose mortality rates than females. It is unclear whether there are sex-related disparities at different stages in the trajectory of opioid use disorders, in “real world” settings.

Goal To determine sex disparities in non-medical opioid use (NMOU) at the end of outpatient medication-assisted treatment (MAT), using nationally representative data.

Design Observational epidemiological study of publicly funded outpatient MAT programs in the national “Treatment episode data set-discharges” (TEDS-D) for 2019.

Participants Persons aged ≥18 in their first treatment episode, in outpatient MAT for use of heroin or other opioids (N=11,549). The binary outcome was presence/absence of NMOU.

Results In univariate analyses, males had significantly higher odds of NMOU, compared to females (odds ratio=1.27; Chi2 [df:1]=39.08; uncorrected p<0.0001; p=0.0041 after Bonferroni correction). A multivariable logistic regression detected a male>female odds ratio of 1.19 (95%CI=1.09-1.29; p<0.0001), adjusting for socio-demographic/clinical variables. Several specific conditions were revealed in which males had greater odds of NMOU compared to females (e.g., at ages 18-29 and 30-39; corrected p=0.012, or if they used opioids by inhalation; corrected p=0.0041).

Conclusions This nationally representative study indicates that males have greater odds of NMOU in their first episode of MAT, indicating more unfavorable outcomes. The study reveals specific socio-demographic and clinical variables under which this sex disparity is most prominent.

Highlights *It is unclear if there are sex-related disparities in outcomes for outpatient opioid medication-assisted therapy (MAT), in large-scale “real world” settings.

*In this nationally representative “real world” study, adult males had significantly greater odds of non-medical opioid use (NMOU) in the month prior to discharge from their first MAT episode compared to females, adjusting for socio-demographic and clinical variables. Males were at higher risk than females for this undesirable outcome under several conditions (e.g., in younger age categories, or if their route of NMOU was by inhalation.

*Sex disparities in MAT outcomes occur under specific conditions that can be examined and potentially addressed, with the goal of improving personalized approaches for OUD.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This work was supported by NIDA U01DA053625 (ERB), and NIDA 1RO1DA048301-01A1 (RZG), and NIDA 1RO1DA049547 (NAK), as well as NIDA Intramural funds, and from Samaritan Daytop Village.

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https://www.datafiles.samhsa.gov/dataset/teds-d-2019-ds0001-teds-d-2019-ds0001

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Abbreviations95%CI95% confidence intervalsAUROCArea under the receiver-operating curvedfdegrees of freedomLOSLength of service (duration of treatment episode)MATmedication-assisted therapy for opioid use disordersNMOUnon-medical opioid use in the month prior to discharge (binary outcome under study)NSNot significantRefReference category for multivariable logistic regressionTEDS-DTreatment episode data set - DischargesMORmu-opioid receptor