Marsh Research Projects

Gender Disparities in OpioidTx

The Gender Disparities in OpioidTx project is a National Institute on Drug Abuse (NIDA) funded R01 research grant titled, “Gender Disparities in Access and Engagement in Medication-Assisted Treatment for Opioid Use Disorder.” Professor Jeanne C. Marsh is the Principle Investigator (PI) for this project, which is a longitudinal analyses of gender difference in entry, access, and engagement in medication-assisted treatment (MAT) for opioid use disorder (OUD). The project team includes leading experts in gender disparities (Dr. Marsh), MAT access (Drs. Erick Guerrero and Hortensia Amaro) and advanced longitudinal approaches (Dr. Yinfei Kong). This work will document the impact of Medicaid expansion, through the Affordable Care Act, on women’s MAT entry, access and engagement. Our findings will inform health care policies and practices and advance systems science and practice guidelines to enhance access to and engagement in care for women with OUD, one of the most vulnerable populations affected by the current opioid epidemic.

Latest research from the project

March 2022 – “Disparities in opioid treatment access and retention among women based on pregnancy status from 2006 to 2017” by Tenie Khachikian, Hortensia Amaro, Erick Guerrero, Yinfei Kong, and Jeanne C. Marsh

In this study, the researchers assessed for differences in wait time and retention in opioid use disorder (OUD) treatment among a sample of pregnant and non-pregnant women from low-income urban communities in Los Angeles, California. Data were collected in 9 waves consisting of consecutive years from 2006 to 2011, and then including 2013, 2015, and 2017. The sample consisted of 12,558 women, with 285 being pregnant and 12,273 being non-pregnant. They compared pregnant women with non-pregnant women at admission on key characteristics and relied on two multilevel negative binomial regressions analyses to examine factors related to access (days on the waiting list) and retention (days in treatment). The researchers detected disparities existed in access and retention. Pregnant women spent less time waiting to initiate treatment than non-pregnant women and, once in treatment, had longer treatment episodes. Among pregnant women, clients identifying as Latina or Other waited longer to enter treatment compared to clients identifying as non-Latina White or Black. Women entering residential waited longer than those entering methadone or counseling services. Pregnant women were more likely to be in treatment longer if they had mental health issues, greater parenting responsibilities (number of children less than 18), and greater SUD severity (number of prior treatment episodes). Their Findings suggest pregnant women’s access and retention can be improved through Medicaid coverage and through the implementation of a standard of care that includes MOUD (methadone) along with ancillary health and social services.

June 2021 – “Gender disparities in opioid treatment progress in methadone versus counseling” by Erick Guerrero, Hortensia Amaro, Yinfei Kong, Tenie Khachikian, and Jeanne C. Marsh

In this publication, the OpioidTx research team conducted a study in which they analyzed multi-year and multi-level (treatment program and client-level) data using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset that was collected in Los Angeles County, California. The researchers looked at two outcomes: making progress towards completing treatment plans and completing treatment plans. The study found gender differences in the two treatment outcomes for outpatient program service types (MOUD-methadone vs. counseling). More specifically, clients who received methadone treatment but not counseling had lower odds of completing their treatment plan. Even more, female clients receiving methadone had lower odds of making progress in and completing their treatment plan than male clients receiving counseling. Latina clients also had lower odds of completing their treatment plans than non-Latina clients. The study calls for health policy and program designs that take into account the need for comprehensive and culturally responsive services in methadone-based programs to improve OUD treatment outcomes among women.

April 2021 – “Gender disparities in access and retention in outpatient methadone treatment for opioid use disorder in low-income urban communities” by Jeanne C. Marsh, Hortensia Amaro, Yinfei Kong, Tenie Khachikian, and Erick Guerrero

In this publication, Jeanne C. Marsh (CHAS Director) and the OpioidTx research team examine access and retention among outpatient methadone treatment programs located in low-income urban communities in Los Angeles, California. The researchers collected client- and program-level data in four waves between 2011 and 2017 from publicly funded methadone treatment programs that served more than 11,000 clients with opioid use disorder (OUD). The study revealed gender disparities in both access and retention where women waited longer than men to access treatment and also remained in treatment longer. The study also highlights that female clients who identified as African American, Latino, and Other were more likely to have a shorter treatment duration than clients who identified as non-Latino white and men. Clients with OUD receiving methadone treatment in low-income communities faced a number of barriers related to treatment access and retention. They recommend improving treatment access and retention for women with OUD through comprehensive, gender-specific, and evidence-based programming. 

HRSA’s Financial Analysis Research Agenda (FARA)

Federally funded health centers (HCs), which receive financial support from the Bureau of Primary Health Care (BPHC) at the Health Resources and Services Administration (HRSA) and the United States Department of Health and Human Services (HHS), have been the flagship direct primary care safety net support program for the federal government since its inception in the 1960’s. The HRSA funded Financial Analysis Research Agenda (FARA) aims to produce manuscripts, reports, and on-going data to demonstrate the value, capacity, and impact of the Health Center Program. Professor Jeanne C. Marsh, along with co-lead author Dr. Harold Pollack and co-authors Dr. Neda Laiteerapong and Dr. Robert Nocon, are using Medicaid claims data to compare the quality and cost of integrated primary and behavioral health care provided by health centers, specialty substance use disorder (SUD) treatment providers, and physician offices for patients with diagnosed substance use disorders. This project team will focus on opioid use disorders, given the magnitude of this public health challenge. Federally Qualified Health Centers (FQHC’s) play an important role in provision of medication-assisted treatment (MAT), specifically integrated buprenorphine maintenance treatment (BMT) for vulnerable and disadvantaged populations.

Provision of Housing Services in U.S. Inpatient Hospital Settings: A Systematic Review

This project is a systematic review aimed at understanding the provision of housing services in U.S. inpatient hospitals. This review stemmed from interest in the role of the health care system in addressing social needs of patients. Professor Jeanne C. Marsh is overseeing the project analysis, along with Crown Family School PhD candidate Hannah MacDougall performing the review and research.