Urban Stress and Opioid Use Disorder: Exploring the Influence of Neighborhood and Individual Stressors on Methadone Treatment Outcomes

Abstract

Retention and engagement in treatment for opioid use disorder (OUD) remains a significant challenge. Many individuals drop out of treatment prematurely, furthering the effects of the opioid epidemic in the United States. Urban communities are disproportionately affected by the crisis, and low-income and minoritized individuals in these areas often demonstrate low engagement in treatment despite the availability of substance use resources. Neighborhood disorder and individual daily stressors may contribute to poor treatment outcomes, but research on the impact of these factors is limited. This dissertation used a convergent mixed methods design to qualitatively understand how patients with OUD residing in a low-income urban community perceive neighborhood factors and stressors while engaged in treatment; and quantitatively investigate the direct relationships between perceived neighborhood disorder, daily stressors, and methadone treatment outcomes. Study participants were recruited from a methadone treatment program in Baltimore as part of a larger parent study which is a clinical trial evaluating a peer-delivered behavioral intervention to improve methadone treatment retention. The qualitative component used thematic analysis of newly collected semi-structured interviews from 18 participants to identify successes and barriers to treatment related to neighborhood stressors. The quantitative component collected survey data to analyze the associations between perceived neighborhood disorder, stressors (both measured through self-reported survey questions), and treatment outcomes, which were assessed by clinic reported continuation in treatment and the number of missed methadone doses within the 90 days following the completion of the surveys, among 71 participants enrolled in the methadone program. Mixed methods meta inferences demonstrated convergence between qualitative and quantitative findings, particularly regarding the social environment, safety concerns, and economic disadvantage, with comparatively less congruence observed for physical environment findings.