{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:32:40Z","timestamp":1777923160826,"version":"3.51.4"},"reference-count":48,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2023,7,1]],"date-time":"2023-07-01T00:00:00Z","timestamp":1688169600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000058","name":"Substance Abuse and Mental Health Services Administration","doi-asserted-by":"publisher","award":["1H79TI085748"],"award-info":[{"award-number":["1H79TI085748"]}],"id":[{"id":"10.13039\/100000058","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Abuse"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Since 2017, Missouri has increased access to medication for opioid use disorder (OUD) within the State\u2019s publicly-funded substance use specialty treatment system through a \u201cMedication First\u201d approach. Results from a statewide assessment of the first year of State Targeted Response implementation showed increases and improvements in overall treatment admissions, medication utilization, and treatment retention. The current study, which focuses on the St. Louis region, the epicenter of Missouri\u2019s overdose crisis, examines whether improvements were experienced equally among Black and White clients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study is a retrospective analysis using state-level billing records for individuals with OUD receiving services through publicly-funded substance use treatment programs between July 1, 2016, and June 30, 2019, with claimed services updated through November 1, 2020. Comparisons across time periods, treatment groups, and Black and White clients were assessed using chi-square tests of independence and multivariate negative binomial regressions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>White individuals in St. Louis experienced larger increases in treatment admissions and utilization of medications for OUD than Black individuals, and Black clients were retained in treatment for shorter lengths of time than White clients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In Missouri, rates of drug overdose deaths are more than three times higher for Black people than White people. Racial inequities in OUD treatment utilization and retention must be intentionally targeted and corrected as one component of reducing this sizable disparity in fatalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08897077231186213","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T04:42:19Z","timestamp":1694580139000},"page":"184-195","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Outcomes of State Targeted\/Opioid Response Grants and the Medication First Approach: Evidence of Racial Inequities in Improved Treatment Access and Retention"],"prefix":"10.1177","volume":"44","author":[{"given":"Rachel","family":"Winograd","sequence":"first","affiliation":[{"name":"Missouri Institute of Mental Health, University of Missouri\u2014St. Louis, St. Louis, MO, USA"},{"name":"Department of Psychological Sciences, University of Missouri\u2014St. Louis, St. Louis, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zach","family":"Budesa","sequence":"additional","affiliation":[{"name":"Missouri Institute of Mental Health, University of Missouri\u2014St. Louis, St. Louis, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devin","family":"Banks","sequence":"additional","affiliation":[{"name":"Department of Psychological Sciences, University of Missouri\u2014St. Louis, St. Louis, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Carpenter","sequence":"additional","affiliation":[{"name":"Department of Psychological Sciences, University of Missouri\u2014St. Louis, St. Louis, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire A.","family":"Wood","sequence":"additional","affiliation":[{"name":"Missouri Institute of Mental Health, University of Missouri\u2014St. Louis, St. Louis, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Duello","sequence":"additional","affiliation":[{"name":"Missouri Institute of Mental Health, University of Missouri\u2014St. Louis, St. Louis, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Thater","sequence":"additional","affiliation":[{"name":"Missouri Institute of Mental Health, University of Missouri\u2014St. Louis, St. Louis, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Behavioral Health, Missouri Department of Mental Health, Jefferson City, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"key":"bibr1-08897077231186213","unstructured":"Centers for Disease Control and Prevention. Drug Overdose Deaths Rise, Disparities Widen. CDC. 2022. Accessed May 16, 2023. https:\/\/www.cdc.gov\/vitalsigns\/overdose-death-disparities\/index.html"},{"key":"bibr2-08897077231186213","unstructured":"Missouri Department of Health & Senior Services. Drug Overdose Dashboard - Fatal Overdoses. 2023. Accessed December 22, 2022. https:\/\/health.mo.gov\/data\/opioids\/"},{"key":"bibr3-08897077231186213","unstructured":"U.S. Census Bureau. ACS Demographic and housing estimates. 2021. Accessed December 22, 2022. https:\/\/data.census.gov\/table?g=0400000US29&tid=ACSDP1Y2021.DP05"},{"key":"bibr4-08897077231186213","unstructured":"Opioid Overdose Deaths by Race\/Ethnicity. KFF. May 15, 2023. Accessed June 1, 2023. https:\/\/www.kff.org\/other\/state-indicator\/opioid-overdose-deaths-by-raceethnicity\/"},{"key":"bibr5-08897077231186213","unstructured":"Missouri Overdose Information. MIMH Addiction Science. April 2022. Accessed May 16, 2022. https:\/\/www.mimhaddisci.org\/missouri-overdose-data"},{"key":"bibr6-08897077231186213","unstructured":"Saint Louis County Department of Public Health. Substance-Involved Deaths St. Louis County, Missouri. Saint Louis Department of Public Health. 2021. Accessed December 22, 2022. https:\/\/stlouiscountymo.gov\/st-louis-county-departments\/public-health\/health-data-and-statistics\/chronic-disease-reports\/drug-overdose\/drug-overdose-deaths-2020\/"},{"key":"bibr7-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1080\/00952990.2019.1605372"},{"key":"bibr8-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2018.3000"},{"key":"bibr9-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.7374"},{"key":"bibr10-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa2212412"},{"key":"bibr11-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2019.1640831"},{"key":"bibr12-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108454"},{"key":"bibr13-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1016\/J.DRUGPO.2018.04.004"},{"key":"bibr14-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2018.05.033"},{"key":"bibr15-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2015.12.007"},{"key":"bibr16-08897077231186213","doi-asserted-by":"publisher","DOI":"10.4314\/ajpsy.v12i3.48497"},{"key":"bibr17-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2019.06.015"},{"key":"bibr18-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000555"},{"key":"bibr19-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2014.12.011"},{"key":"bibr20-08897077231186213","unstructured":"Delucchi KL. On the Use and Misuse of Chi-Square. University of California; 1993. Accessed December 22, 2022. https:\/\/files.eric.ed.gov\/fulltext\/ED204399.pdf"},{"key":"bibr21-08897077231186213","unstructured":"R Core Team. R: A language and environment for statistical computing. 2022. Accessed December 2, 2022. https:\/\/www.r-project.org\/"},{"key":"bibr22-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-21706-2"},{"key":"bibr23-08897077231186213","unstructured":"Lenth R. emmeans: Estimated marginal means, aka least-squares means. 2022. Accessed December 2, 2022. https:\/\/CRAN.R-project.org\/package=emmeans"},{"key":"bibr24-08897077231186213","unstructured":"Jones A, Honermann B, Sharp A, Millett G. Where multiple dodes of Medication-Assisted Treatment are available. Health Affairs. January 9, 2018. Accessed December 22, 2022. https:\/\/www.healthaffairs.org\/do\/10.1377\/forefront.20180104.835958\/full\/"},{"key":"bibr25-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.0846"},{"key":"bibr26-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.3821"},{"key":"bibr27-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1097\/HRP.0000000000000285"},{"key":"bibr28-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108087"},{"key":"bibr29-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1037\/a0037929"},{"key":"bibr30-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2022.3673"},{"key":"bibr31-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2018.07.030"},{"key":"bibr32-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1111\/dar.13058"},{"issue":"1","key":"bibr33-08897077231186213","first-page":"35","volume":"17","author":"Williams I","year":"2020","journal-title":"J Soc Work Values Ethics"},{"key":"bibr34-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1097\/adm.0b013e31820497ae"},{"key":"bibr35-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.13326"},{"key":"bibr36-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2017.07.011"},{"key":"bibr37-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1111\/j.1521-0391.2013.12109.x"},{"key":"bibr38-08897077231186213","unstructured":"Goodman M, Gilbert K. Divided Cities Lead to Differences in Health. Washington University in St. Louis; 2013:1-6. Accessed December 23, 2022. https:\/\/forthesakeofall.files.wordpress.com\/2013\/11\/policy-brief-4.pdf"},{"key":"bibr39-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1016\/j.tra.2008.01.011"},{"key":"bibr40-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2013.11.002"},{"key":"bibr41-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.3711"},{"key":"bibr42-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-023-00734-9"},{"key":"bibr43-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1007\/s40429-023-00489-0"},{"key":"bibr44-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1177\/1073110518782949"},{"key":"bibr45-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1080\/15332640.2014.976803"},{"key":"bibr46-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2022.108805"},{"key":"bibr47-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1111\/add.13238"},{"key":"bibr48-08897077231186213","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000001104"}],"container-title":["Substance Abuse"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08897077231186213","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08897077231186213","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08897077231186213","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T20:40:17Z","timestamp":1777668017000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08897077231186213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7]]},"references-count":48,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1177\/08897077231186213"],"URL":"https:\/\/doi.org\/10.1177\/08897077231186213","relation":{},"ISSN":["0889-7077","1547-0164"],"issn-type":[{"value":"0889-7077","type":"print"},{"value":"1547-0164","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7]]}}}