Receipt of medications for opioid use disorder among minoritized racial and ethnic groups in the United States: A systematic review and meta-analysis
Creators: name: Chen, Jessica Ann
name: Goldberg, Simon
name: Ms. Melissa Barnes
name: Dr. Felicia Mata-Greve
name: Williams, Emily C
name: Frost, Madeline C.
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Medicine and Health Sciences
subject: Mental and Social Health
subject: disparities
subject: opioid use disorder
subject: mental health
subject: meta analysis
subject: racism
subject: substance use
subject: health equity
subject: service delivery
subject: systematic review

description: Review Title: Receipt of medications for opioid use disorder among minoritized racial and ethnic groups in the United States: A systematic review and meta-analysis Anticipated or actual start date: 1 February 2022. Anticipated completion date: 15 December 2022. Stage of the review at time of this submission. a. The review has not yet started: No b. Preliminary searches: Yes c. Piloting of the study selection process: No d. Formal screening of search results against eligibility criteria: No e. Data extraction: No f. Risk of bias (quality assessment): No g. Data analysis: No h. Provide any other relevant information about the stage of the review here: We have examined preliminary searches, search terms, ways to find gray literature within our topic, consulted with a librarian about our proposed methodology/search, and identified a screening tool for biases (JBI Tool). The review seeks to answer the following questions: i. What is the range of prevalence of MOUD receipt and retention among minoritized racial and ethnic groups in the U.S.? ii. Are there inequitable outcomes in the availability/delivery/receipt of or retention in MOUD between minoritized groups and non-Hispanic Whites in the U.S? 1. If so, then what are the magnitudes of the inequities for different racialized and ethnic groups and different medication types? iii. How do contextual factors influence receipt of MOUD among minoritized populations and inequities? Searches a. Sources: PubMed (includes all of MEDLINE), EMBASE, PsycINFO, and CINAHL Complete. b. Grey Literature: We will use Web of Science to search for grey literature (e.g., organizational health equity reports, theses/dissertations, conference abstracts, and other unpublished evidence). We will reach out to researchers through listservs for SUD, multicultural, and health equity research (call for evidence sharing). We will hand-search included articles and their references to look for mentions of unpublished datasets. c. Search dates: February – March 2022. d. Restrictions: Exclusion criteria will include: (a) non-U.S. setting, (b) data do not report race or ethnicity or do not include people of color, or include people of color and White patients but do not report by race and ethnicity, (c) non-English language study, (d), not related to opioid use disorder, (e) non-human study, (f) includes children. URL to search strategy; Search strategy added as a supplementary PDF file. Will not be made publicly available until the review is complete. Condition or domain being studied: Opioid use disorder (OUD). Opioids include both synthetic and natural chemicals that reduce the sensation of pain. Some opioids are commonly prescribed to relieve pain after particular procedures or in the context of certain medical conditions. Opioid use disorder occurs when an individual has a problematic pattern of use for 12 months. For example, problematic use may include craving, problems completing day-to-day responsibilities, using in dangerous scenarios, and experiencing tolerance, to name a few (American Psychiatric Association, 2013). Drug overdoses are linked to approximately 92,000 deaths each year, with the number of deaths linked to opioids increasing dramatically each year. Of note, opioid use was named a nationwide crisis in October 2017 (American Psychiatric Association, 2018). Participants/population. a. Inclusion criteria includes: (a) adults (ages 18 and older), (b) populations with opioid use disorder (OUD) or at risk of OUD, and (c) persons residing in the U.S. Exclusion criteria includes (a) individuals not living in the U.S., (b) persons that do not have their racial and/or ethnic background specified, and (c) minors (17 years old and younger). Intervention(s), exposure(s): Exposure to racism is the exposure of interest. Therefore, the project centers on individuals identifying as part of a racial or ethnic group in the U.S. at risk for experiencing racism or ethnic discrimination (e.g., Black/African American, Latinx/Hispanic American, American Indian/Native American/Alaska Native, Native Hawaiian/Pacific Islander, Asian/Asian-American). Comparator(s)/control: When data are available, comparisons will be made between minoritized racial/ethnic groups and the dominant racial group in the U.S. that is not at risk for experiencing racism (non-Hispanic White). Types of studies to be included: The types of studies that we will include are: empirical journal articles, including longitudinal/cohort, retrospective, prospective, and cross-sectional observational studies as well as clinical trials. Context. a. There are no other inclusion or exclusion criteria other than what is listed above. b. We will also be extracting information on various contextual factors beyond the exposure &amp; comparator, such as study characteristics (e.g., time period, data source), treatment setting, etc. Main outcome(s): Availability, delivery, and receipt of medications for opioid use disorder (MOUD) and retention in MOUD. MOUD includes first-line opioid agonist (buprenorphine or methadone) and second-line injectable naltrexone. Measures of effect: Measures of frequency and/or association: ex., counts, proportions, rates, odds ratios Additional outcome(s): When available, we will also extract data on MOUD clinical outcomes (e.g., abstinence, overdose, mortality) to examine associations with receipt of care and retention to further contextualize the impact of racism on patients with OUD. The primary goal is not to evaluate the efficacy of MOUD. Measures of effect: ex., rates, days, survival probabilities, relative risk, odds ratios Data extraction (selection and coding). a. Study selection i. We will conduct a preliminary study audit and abstract review (N=20) to confirm the validity of the search strategy and PICOTS/ inclusion and exclusion specification. ii. All search results will be imported into systematic review software, such as Covidence, for de-duplication and review. Two reviewers (JC, FMG, or MB) will independently screen titles and abstracts against the eligibility criteria. Full-text articles will be reviewed for all records that potentially meet the inclusion criteria, and final inclusion will be determined by full-text review. Researchers will be not see each other’s decisions prior to screening. When there are discrepancies, they will be resolved by mutual discussion and/or discussion with a third reviewer. There will also be ongoing group consultation. b. Data extraction i. Extracted data will include the study purpose, characteristics, and sample characteristics and size; main findings; and outcome measures relevant to availability/delivery/receipt of or retention in MOUD. Other data that may be extracted include: other treatment characteristics (e.g., different buprenorphine formulations), other patient characteristics (e.g., gender, age) ii. Two people will independently extract data. Risk of bias (quality assessment): Reviewers (JC, FMG, and MB) will use the critical appraisal tools provided by Joanna Briggs Institute. Strategy for data synthesis: A systematic review will be performed using a systematic review software (Covidence). If enough studies are available that include the relevant outcomes reported by race/ethnicity and include the relevant comparator group (minimum k=4), then we will conduct a meta-analysis on measures of effect (e.g., odds ratios) and calculate pooled effect sizes with 95% confidence intervals. Analysis of subgroups or subsets. Planned subgroup analyses include comparisons of minoritized racial groups (both individually and as a single group) vs. non-Hispanic White. Another planned subgroup analysis is to examine results by medication type (buprenorphine vs. methadone). Exploratory analyses may include how study characteristics, community characteristics, treatment setting, and patient characteristics influence the associations of interest. Type and method of review: Meta-analysis, Systematic review Health areas: alcohol/substance misuse/abuse; health inequalities/health equity; mental health and behavioural conditions; service delivery Language: English Country: United States of America Dissemination plans. Do you intend to publish the review on completion? Yes. Keywords: Systematic review; meta analysis; opioid use disorder; opioid use disorder treatment; racial disparities Details of any existing review of the same topic by the same authors: N/A Current review status: Ongoing