Disparities in access to buprenophine maintenance for opioid dependence by ethnicity and socioeconomic status in the U.S. [1] raise the question of whether unrecognized stigma and marginalization within systems of care will intensify inequities in treatment, as addiction is clinically treated as a chronic medical illness in the priate sector, and integrated into office-based practices [2]. This project investigates the influence of mainstreaming buprenophine maintenance treatment for opioid dependence into general medicine clinics on the perceived stigma and social networks of patients. Focusing on public clinics that serve low income and ethnic minority patients, but have been slow to adopt buprenophine treatment, it also examines institutional and professional influences on buprenophine adoption by providers. The project uses mixed social science research methods, and will involve observational case studies of clinics, semi-structured interviews, longitudinal measures of perceived stigma, and social network analysis. These will be undertaken in five clinics that vary by setting (general medicine versus substance abuse specialty), patient demographics (ethnicity and socioeconomic status), and the speed with which clinic staff adopt buprenophine maintenance. Disparities in access to buprenophine in the U.S. are predicted by studies of technology dissemination of treatment for a wide range of health conditions, which demonstrate that improved technologies often widen treatment gaps between advantaged and disadvantaged patient groups[3], and in the case of mental health and addiction, affect stigma differently among disadvantaged groups[4,5,6]. This project seeks to illuminate institutional and socioeconomic determinants of treatments and outcomes, with a focus on the relationship of stigma and social resources to clinical setting (general medicine versus substance abuse clinic) and patient demographics. This project thereby addresses a core NIH goal of reducing disparities in access to health care.

Public Health Relevance

The proposed program of research and training for this career award are relevant to three public health goals of the National Institute of Drug Abuse: 1) it prepares an interdisciplinary investigator with a unique background in sociocultural research and clinical psychiatry for independent research that will bring social science to bear on health services research problems. This advances the goal of the K01 Mentored Research Scientist Development Award program by enhancing the supply of health researchers that are qualified to address complex health problems as future principal investigators. 2) The interdisciplinary nature of the investigator's proposed methods, advisory committee, research training and coursework, which draw from anthropology, sociology, and health services research, will advance a core missions of NIDA: to bring science from a broad range of disciplines to bear on addiction. 3) Findings from this project will be geared toward health services administrators and policy makers, as a result of the investigator's advising and training from health services researchers. This will advance a second core mission of NIDA: to ensure dissemination of research findings to improve addiction treatment.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01DA032674-04
Application #
8792378
Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Duffy, Sarah Q
Project Start
2012-02-15
Project End
2017-01-31
Budget Start
2015-02-01
Budget End
2016-01-31
Support Year
4
Fiscal Year
2015
Total Cost
$180,652
Indirect Cost
$13,382
Name
New York University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
121911077
City
New York
State
NY
Country
United States
Zip Code
10016
Hatcher, Alexandrea E; Mendoza, Sonia; Hansen, Helena (2018) At the Expense of a Life: Race, Class, and the Meaning of Buprenorphine in Pharmaceuticalized ""Care"". Subst Use Misuse 53:301-310
Polydorou, Soteri; Ross, Stephen; Coleman, Peter et al. (2017) Integrating Buprenorphine Into an Opioid Treatment Program: Tailoring Care for Patients With Opioid Use Disorders. Psychiatr Serv 68:295-298
Hansen, Helena; Metzl, Jonathan M (2017) New Medicine for the U.S. Health Care System: Training Physicians for Structural Interventions. Acad Med 92:279-281
Gupta, Vishal K; Hansen, Helena; Mendoza, Sonia et al. (2017) Merging Outpatient Addiction and Opioid-Maintenance Programs During A Disaster: Lessons From Hurricane Sandy. Disaster Med Public Health Prep 11:531-537
Netherland, Julie; Hansen, Helena (2017) White opioids: Pharmaceutical race and the war on drugs that wasn't. Biosocieties 12:217-238
Vaughn, Rubiahna L; Smith, Lianne Morris; Bernstein, Carol A et al. (2016) Expanding the Pipeline: The New York University School of Medicine-University of Ghana School of Medicine and Dentistry Psychiatric Education Initiative. Int J Ment Health 45:154-159
Kirane, Harshal; Ketteringham, Michael; Bereket, Sewit et al. (2016) Awareness and Attitudes Toward Intranasal Naloxone Rescue for Opioid Overdose Prevention. J Subst Abuse Treat 69:44-9
Reich, Adam D; Hansen, Helena B; Link, Bruce G (2016) Fundamental Interventions: How Clinicians Can Address the Fundamental Causes of Disease. J Bioeth Inq 13:185-92
Hansen, Helena; Siegel, Carole; Wanderling, Joseph et al. (2016) Buprenorphine and methadone treatment for opioid dependence by income, ethnicity and race of neighborhoods in New York City. Drug Alcohol Depend 164:14-21
Hansen, Helena; Netherland, Julie (2016) Is the Prescription Opioid Epidemic a White Problem? Am J Public Health 106:2127-2129

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