Attitudes toward methadone among out-of-treatment minority injection drug users: implications for health disparities.

Nickolas D Zaller,Alexander R Bazazi,Lavinia Velazquez,Josiah D Rich

doi:10.3390/ijerph6020787

Abstract

Injection drug use (IDU) continues to be a significant public health issue in the U.S. and internationally, and there is evidence to suggest that the burden of injection drug use and associated morbidity and mortality falls disproportionately on minority communities. IDU is responsible for a significant portion of new and existing HIV/AIDS cases in many parts of the world. In the U.S., the prevalence of HIV and hepatitis C virus is higher among populations of African-American and Latino injection drug users (IDUs) than among white IDUs. Methadone maintenance therapy (MMT) has been demonstrated to effectively reduce opiate use, HIV risk behaviors and transmission, general mortality and criminal behavior, but opiate-dependent minorities are less likely to access MMT than whites. A better understanding of the obstacles minority IDUs face accessing treatment is needed to engage racial and ethnic disparities in IDU as well as drug-related morbidity and mortality. In this study, we explore knowledge, attitudes and beliefs about methadone among 53 out-of-treatment Latino and African-American IDUs in Providence, RI. Our findings suggest that negative perceptions of methadone persist among racial and ethnic minority IDUs in Providence, including beliefs that methadone is detrimental to health and that people should attempt to discontinue methadone treatment. Additional potential obstacles to entering methadone therapy include cost and the difficulty of regularly attending a methadone clinic as well as the belief that an individual on MMT is not abstinent from drugs. Substance use researchers and treatment professionals should engage minority communities, particularly Latino communities, in order to better understand the treatment needs of a diverse population, develop culturally appropriate MMT programs, and raise awareness of the benefits of MMT.

Highlights

Injection drug use (IDU) continues to be a significant public health issue in the U.S and internationally, and there is evidence to suggest that the burden of injection drug use and associated morbidity and mortality falls disproportionately on minority communities
Rates of IDU are similar in Hispanic and nonHispanic white populations, but disparities in IDU are present in some metropolitan areas [2], and the collection of data on Hispanics as a whole may obscure the significant variability between Hispanic subgroups [4,5]
U.S.-born Hispanics report higher rates of substance use than immigrants [6], and among Hispanics diagnosed with AIDS, those born in the U.S.A. or Puerto Rico were more likely to have contracted HIV through IDU than those born in Central or South America, Mexico, or Cuba [7]

Summary

Introduction

Injection drug use (IDU) continues to be a significant public health issue in the U.S and internationally, and there is evidence to suggest that the burden of injection drug use and associated morbidity and mortality falls disproportionately on minority communities. Rates of IDU are similar in Hispanic and nonHispanic white populations, but disparities in IDU are present in some metropolitan areas [2], and the collection of data on Hispanics as a whole may obscure the significant variability between Hispanic subgroups [4,5]. Metropolitan areas with greater white-Latino differences in IDU tend to be located in the Northeast, an area where the majority of Latinos are of Puerto Rican origin [2]. In the Northeast, Latino-white disparities in IDU may be due to the relatively high rates of heroin use and high levels of residential segregation, which has been linked to increased IDU, found among Puerto Ricans living in mainland

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Discussion

Conclusion