Date: 24 May 2013

Variation in Use of Buprenorphine and Methadone Treatment by Racial, Ethnic, and Income Characteristics of Residential Social Areas in New York City

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Introduction

Opiate agonist therapies for opiate dependence lower HIV incidence and arrest rates among injection drug users,13 thus enhancing access to these treatments is a major public health priority. Buprenorphine, a partial opiate receptor agonist approved by the US FDA in 2002 for treatment of opiate dependence, offers important advantages over methadone maintenance. Buprenorphine is less lethal in overdose than methadone.4 The most commonly prescribed formulation of buprenorphine, in which it is combined with the opiate antagonist naloxone, produces opiate withdrawal when injected, limiting its abuse potential.5 Because of these lower risks, buprenorphine can be prescribed by office-based generalist physicians, potentially increasing treatment access and reducing stigma in comparison to methadone,6 which is restricted to federally regulated methadone clinics.

Few physicians offer buprenorphine treatment despite its advantages.7 While policies such as state Medicaid coverage of bu ...