title: Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; VA New England Mental Illness Research and Education Center, West Haven, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States. Electronic address: ajay.manhapra@yale.edu.
authors.forename: Ajay
authors.initials: A
authors.lastname: Manhapra
authors.affiliation: Department of Psychiatry, Harvard Medical School & McLean Hospital, Belmont, MA, United States.
authors.forename: Lantie
authors.initials: L
authors.lastname: Quinones
authors.affiliation: VA New England Mental Illness Research and Education Center, West Haven, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenheck
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D015897:Comorbidity; D003710:Demography / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D002047:Buprenorphine; D008691:Methadone
keywords: Buprenorphine; Demographics; Methadone; Opioid agonist treatment; Opioid use disorder