Study finds connection between low methadone doses, race of program directors

Battling an epidemic of opiate addiction, U.S. drug treatment facilities have made progress with methadone. A daily dose of at least 60 milligrams of methadone is recommended to achieve therapeutic effects and has been associated with improvements that include significant decreases in heroin use, in relapse rates, and in HIV incidence.

Image caption: Jemima A. Frimpong

Some patients of "opiate agonist treatment" facilities, however, receive less than 60 milligrams per day. A team of researchers led by a Johns Hopkins University expert on health care organizations examined differences in methadone dose levels and the role that program directors may play in accounting for these variations.

For a study recently published in Health Services Research, the team discovered that, overall, the proportion of patients getting lower than the recommended daily dose of methadone for opiate addiction has declined in recent years. However, facilities run by African-American directors were more likely to provide low methadone doses than facilities run by managers of other races and ethnicities.

This relationship was even stronger at facilities run by African-American directors serving a high proportion of African-American patients. The paper is among the first to examine the role of managers in addressing opiate addiction.

Lead author Jemima A. Frimpong, an assistant professor at the Johns Hopkins Carey Business School, says the finding was unexpected. She and her co-authors—doctoral candidate Karen Shiu-Yee of Columbia University and Professor Thomas D'Aunno of New York University—set out to determine a possible link between the characteristics of facility managers and the lower doses of methadone. While manager race and ethnicity were conceptually relevant to the analysis, the specific finding regarding African-American managers was not anticipated, Frimpong explains. But its importance became apparent as the researchers examined data compiled from 1995 through 2011 in the National Drug Abuse Treatment System Survey (NDATSS).

Frimpong and her colleagues suggest possible reasons for the lower methadone doses at facilities run by African-American directors—for example, negative perceptions of methadone in the African-American community, and a preference among those directors for psychosocial treatment, including talk therapy, as a supplement to methadone in treating opiate addiction. The authors concede that further research is needed to better understand their finding regarding the relationship between the races of program managers and dosing patterns.

"We know that the problem of low dosing exists, and research has looked at how patient characteristics may play a role," Frimpong says. "Our study extends such analyses and examines characteristics of managers and how they may influence methadone dosing patterns in opioid treatment programs."