Workforce Diversity and Wait Times to Enter Opioid Treatment

Erick Guerrero; Tenie Khachikian; Yinfei Kong; Boya Pang; Daniel Howard

doi:doi:10.11648/j.ajhr.20261402.13

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Workforce Diversity and Wait Times to Enter Opioid Treatment

Erick Guerrero^*

, Tenie Khachikian

, Yinfei Kong

, Boya Pang

, Daniel Howard

Published in American Journal of Health Research (Volume 14, Issue 2)

Received: 9 February 2026 Accepted: 24 February 2026 Published: 5 March 2026

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Abstract

Background: Racial and ethnic minorities face significant disparities in accessing opioid use disorder (OUD) treatment. While workforce diversity is theorized to improve cultural competency, rapport and retention, prior research has yielded mixed results regarding its impact on access, namely wait times. Conversely, workforce diversity may be associated with operational constraints. This study builds on previous work to determine how the association between minority staffing and wait times have changed post-pandemic. Methods: This study analyzes data from the National Drug Abuse Treatment System Survey (NDATSS) for 2017 (n = 101) and 2023 (n = 121) using multilevel linear regression to examine the relationship between staff racial composition and wait times to enter methadone treatment. Results: Consistent with historical trends, higher percentages of African American staff were associated with longer wait times overall. However, a significant interaction with the survey year reveals that this association weakened significantly in 2023 compared to 2017, suggesting a reduction in wait times for programs with diverse staffing in the post-pandemic landscape. Conclusion: The previously observed "cost" of workforce diversity on wait times appears to be diminishing. These findings suggest that evolving organizational practices or policy shifts may be allowing diverse teams to better facilitate timely access to care.

Published in	American Journal of Health Research (Volume 14, Issue 2)
DOI	10.11648/j.ajhr.20261402.13
Page(s)	85-88
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Workforce Diversity, Racial Disparity, Opioid Treatment Access, Wait Times, Organizational Behavior

1. Introduction

Despite national efforts to promote healthcare equity, marked disparities in treatment access and outcomes persist for racial and ethnic minorities

[1-4]

. The opioid crisis has disproportionately affected these communities, with rising mortality rates among African Americans and Latinos

[5-7]

. Systemic barriers, including policy failures and the punitive legacy of the War on Drugs, have historically limited access to Medications for Opioid Use Disorder (MOUD) for these populations

[8]

Workforce diversity is often proposed as a primary mechanism to mitigate these disparities. Racial concordance between provider and patient is linked to enhanced cultural competency, better rapport, and improved treatment retention

[9-13]

. However, empirical evidence regarding the operational impact of diversity on access—specifically wait times—remains complex. While diversity enhances the therapeutic alliance, some organizational studies suggest it may be associated with operational constraints in under-resourced settings

[8, 10, 14]

Extension of Previous Findings

This study builds directly upon and extends the findings of Guerrero et al. (2022)

[8]

, which revealed a nuanced and somewhat counterintuitive pattern: programs with higher proportions of African American staff and clients were generally associated with longer wait times and lower retention rates. The exception to this trend was found in public programs, where diversity correlated with improved access. The 2022 study highlighted a potential "diversity-capacity paradox," where private programs with diverse workforces may have lacked the resources or management structures to process admissions as efficiently as their counterparts. The current study extends this line of inquiry by incorporating new data from 2023. By comparing 2017 and 2023 waves, we aim to determine if the historical association between minority staffing and longer wait times has persisted, or if the post-pandemic landscape and evolving equity policies have shifted this dynamic.

2. Methods

2.1. Sample and Procedures

Data were drawn from the National Drug Abuse Treatment System Survey (NDATSS), a nationally representative longitudinal survey of Opioid Treatment Programs (OTPs). The analytic sample focuses on OTPs providing methadone in 2017 (n = 101) and 2023 (n = 121). The survey utilizes a split-panel design to maintain representativeness while preserving statistical power. Directors and clinical supervisors provided data on organizational structure, financing, staff composition, and wait times. Response rates, weights and data reliability were consistent with established survey protocols

[13, 15]

2.2. Measures

Dependent Variable: The average number of days clients waited to enter OUD treatment. Independent Variables: Percentage of African American staff, percentage of Latino staff, and survey year (2017 vs. 2023). Covariates: Percentage of unemployed clients, Medicaid expansion participation (Yes/No), ownership by another organization, and program type (public, private for-profit, private not-for-profit).

2.3. Analysis

A multilevel linear regression model was fitted to account for the repeated-measures structure of the data (programs surveyed in both waves). We examined the main effects of workforce diversity and the interaction between diversity variables and the survey year to test for changes over time.

3. Results

Descriptive statistics (Table 1) show that the average percentage of African American staff was 27.9% (SD = 26.6), and Latino staff was 11.0% (SD = 17.6).

Table 1. Mean and standard deviation in parenthesis or count and percent in parenthesis of variables in our analysis.

Year
2017	101 (45.5%)
2023	121 (54.5%)
Percent of African American staff	27.9 (26.6)
Percent of Latino staff	11.0 (17.6)
Percent of unemployed clients	54.3 (25.5)
Medicaid expansion	155 (69.8%)
Owned by another organization	51 (24.9%)
Type of programs
Private for-profit	77 (37%)
Private not-for-profit	103 (49.5%)
Public	28 (13.5%)

Table 2 reveals a significant main effect: overall, a higher percentage of African American staff was associated with longer wait times (beta = 0.524, p =.029).

Table 2. Multi-level linear regression models of average wait time.

Yeara	beta	95% CI	p value
2023	-2.846	-20.526, 14.834	0.753
Percent of African American staff	0.524	0.059, 0.989	0.029
Percent of Latino staff	0.026	-0.246, 0.298	0.853
Percent of unemployed clients	0.000	-0.22, 0.22	0.999
Medicaid expansion	2.687	-10.144, 15.518	0.682
Owned by another organization	-9.636	-19.98, 0.707	0.070
Type of programsb
Private for-profit	11.188	-1.535, 23.911	0.087
Private not-for-profit	19.368	-4.081, 42.816	0.108
Interactions
Percent of African American staff* Year 2023	-0.624	-1.123, -0.124	0.015
aPrograms in 2017 as reference; bPublic programs as reference

This replicates the trend found in the 2000–2017 data. However, the interaction term is statistically significant and negative (beta = -0.624, p =.015). This indicates that the relationship changed in 2023. Specifically, the net effect in 2023 (0.524 - 0.624 = -0.100) suggests a slight negative association, meaning that by 2023, programs with higher African American staffing no longer exhibited the "wait time penalty" observed in previous years.

4. Discussion

This study provides a critical update to the literature on workforce diversity and OUD treatment access. Previous research using NDATSS data from 2000–2017 observed a pattern where, particularly in private settings, higher minority staffing levels correlated with longer wait times

[8]

. Our current analysis confirms that while this structural lag existed historically, the dynamic shifted significantly by 2023.

Expanding the Understanding of Access

The significant negative interaction term for 2023 suggests that the organizational "cost" previously associated with diverse workforces is disappearing. In the previous study

[8]

(Guerrero et al., 2022), the longer wait times in diverse programs were attributed to resource constraints common in facilities serving high-minority populations (often private non-profits without the safety net of public funding). The reversal of this trend in the 2023 data—where high African American staffing is no longer associated with delays—implies that these organizations may be becoming more efficient, or that recent equity-focused policies and funding mechanisms (e.g., increased Medicaid expansion uptake) are effectively stabilizing these providers. Furthermore, this finding adds nuance to the "business case" for diversity. It suggests that workforce diversity is not merely a tool for cultural competence or retention (as established in previous literature), but when supported by the evolving healthcare landscape of 2023, it is compatible with efficient access to care. The reduction of the wait time disparity in 2023 indicates that the trade-off between diversity and efficiency is not a fixed organizational rule but a condition modifiable by time, policy, and resource allocation.

Limitations and Conclusion

Limitations include reliance on self-reported survey data and the inability to assess wait times for specific racial subgroups of patients. Self-reported data leans towards subjectivity and personal bias as opposed to empirical data. Moreover, there may be other confounding factors not accounted for in the study not measured in the data. Post-pandemic, many programs have begun to offer tele-health treatment options for their OUD patients. Reducing, or even taking away transportation time and allowing patients to be seen in the comfort of their own home reduces several logistical and mental barriers.

Future research should examine why this shift occurred, whether due to internal management improvements, better external funding for minority-serving institutions, or post-COVID operational changes. Ultimately, these results offer a more optimistic view than previous analyses: promoting representative staffing is increasingly viable as a strategy that supports both equity and timely access to opioid treatment.

Abbreviations

MOUD	Medications for Opioid Use Disorder
OUD	Opioid Use Disorder
NDATSS	National Drug Abuse Treatment System Survey
OTP	Opioid Treatment Program

Author Contributions

Erick Guerrero: Conceptualization, Writing – review & editing

Tenie Khachikian: Writing – original draft, Writing – review & editing, Investigation, Project administration

Yinfei Kong: Data curation, Formal Analysis

Boya Pang: Writing – original draft, Investigation

Daniel Howard: Writing – review & editing

Conflicts of Interest

The authors declare no conflicts of interest.

References

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[2]	Gibbons, J. B., McCullough, J. S., Zivin, K., Brown, Z. Y., & Norton, E. C. (2024). Racial and ethnic disparities in medication for opioid use disorder access, use, and treatment outcomes in Medicare. Journal of substance use and addiction treatment, 157, 209271. https://doi.org/10.1016/j.josat.2023.209271
[3]	Magee, T., Peters, C., Jacobsen, S. M., Nees, D., Dunford, B., Ford, A. I., & Vassar, M. (2023). Inequities in the treatment of opioid use disorder: A scoping review. Journal of substance use and addiction treatment, 152, 209082. https://doi.org/10.1016/j.josat.2023.209082
[4]	Nedjat, S., Wang, Y., Eshtiaghi, K., & Fleming, M. (2024). Is there a disparity in medications for opioid use disorder based on race/ethnicity and gender? A systematic review and meta-analysis. Research in social & administrative pharmacy: RSAP, 20(3), 236–245. https://doi.org/10.1016/j.sapharm.2023.12.001
[5]	Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid crisis: No easy fix to its social and economic determinants. American Journal of Public Health, 108(2), 182–186. https://doi.org/10.2105/AJPH.2017.304187
[6]	Office of Budget Policy and Analysis. (2022, November). Continuing Crisis: Drug Overdose Deaths in New York. Office of New York State Comptroller. https://www.osc.ny.gov/reports/continuing-crisis-drug-overdose-deaths-new-york (accessed January 2026).
[7]	Valdez, A., Cepeda, A., Frankeberger, J., & Nowotny, K. M. (2022). The opioid epidemic among the Latino population in California. Drug and alcohol dependence reports, 2, 100029. https://doi.org/10.1016/j.dadr.2022.100029
[8]	Guerrero, E. G., Kong, Y., Frimpong, J. A., Khachikian, T., Wang, S., D’Aunno, T., & Howard, D. L. (2022). Workforce diversity and disparities in wait time and retention among opioid treatment programs. Substance Abuse Treatment, Prevention, and Policy, 17(1), 74. https://doi.org/10.1186/s13011-022-00500-3
[9]	Cooper-Patrick, L., Gallo, J. J., Gonzales, J. J., Vu, H. T., Powe, N. R., Nelson, C., & Ford, D. E. (1999). Race, gender, and partnership in the patient-physician relationship. JAMA, 282(6), 583–589. https://doi.org/10.1001/jama.282.6.583
[10]	Lynch, S., Katkhuda, F., Klepacz, L., Towey, E., & Ferrando, S. J. (2023). Racial disparities in opioid use disorder and its treatment: A review and commentary on the literature. Journal of Mental Health and Clinical Psychology, 7(1), 13-18. https://doi.org/10.29245/2578-2959/2023/1.1263
[11]	Moore, C., Coates, E., Watson, A., de Heer, R., McLeod, A., & Prudhomme, A. (2023). Correction to: "It's Important to Work with People that Look Like Me": Black Patients' Preferences for Patient-Provider Race Concordance. Journal of racial and ethnic health disparities, 10(5), 2614. https://doi.org/10.1007/s40615-022-01489-y
[12]	Shen, M. J., Peterson, E. B., Costas-Muñiz, R., Hernandez, M. H., Jewell, S. T., Matsoukas, K., & Bylund, C. L. (2018). The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature. Journal of racial and ethnic health disparities, 5(1), 117–140. https://doi.org/10.1007/s40615-017-0350-4
[13]	Takeshita, J., Wang, S., Loren, A. W., Mitra, N., Shults, J., Shin, D. B., & Sawinski, D. L. (2020). Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA network open, 3(11), e2024583. https://doi.org/10.1001/jamanetworkopen.2020.24583
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APA Style

Guerrero, E., Khachikian, T., Kong, Y., Pang, B., Howard, D. (2026). Workforce Diversity and Wait Times to Enter Opioid Treatment. American Journal of Health Research, 14(2), 85-88. https://doi.org/10.11648/j.ajhr.20261402.13

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ACS Style

Guerrero, E.; Khachikian, T.; Kong, Y.; Pang, B.; Howard, D. Workforce Diversity and Wait Times to Enter Opioid Treatment. Am. J. Health Res. 2026, 14(2), 85-88. doi: 10.11648/j.ajhr.20261402.13

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AMA Style

Guerrero E, Khachikian T, Kong Y, Pang B, Howard D. Workforce Diversity and Wait Times to Enter Opioid Treatment. Am J Health Res. 2026;14(2):85-88. doi: 10.11648/j.ajhr.20261402.13

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@article{10.11648/j.ajhr.20261402.13,
  author = {Erick Guerrero and Tenie Khachikian and Yinfei Kong and Boya Pang and Daniel Howard},
  title = {Workforce Diversity and Wait Times to Enter Opioid Treatment},
  journal = {American Journal of Health Research},
  volume = {14},
  number = {2},
  pages = {85-88},
  doi = {10.11648/j.ajhr.20261402.13},
  url = {https://doi.org/10.11648/j.ajhr.20261402.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20261402.13},
  abstract = {Background: Racial and ethnic minorities face significant disparities in accessing opioid use disorder (OUD) treatment. While workforce diversity is theorized to improve cultural competency, rapport and retention, prior research has yielded mixed results regarding its impact on access, namely wait times. Conversely, workforce diversity may be associated with operational constraints. This study builds on previous work to determine how the association between minority staffing and wait times have changed post-pandemic. Methods: This study analyzes data from the National Drug Abuse Treatment System Survey (NDATSS) for 2017 (n = 101) and 2023 (n = 121) using multilevel linear regression to examine the relationship between staff racial composition and wait times to enter methadone treatment. Results: Consistent with historical trends, higher percentages of African American staff were associated with longer wait times overall. However, a significant interaction with the survey year reveals that this association weakened significantly in 2023 compared to 2017, suggesting a reduction in wait times for programs with diverse staffing in the post-pandemic landscape. Conclusion: The previously observed "cost" of workforce diversity on wait times appears to be diminishing. These findings suggest that evolving organizational practices or policy shifts may be allowing diverse teams to better facilitate timely access to care.},
 year = {2026}
}

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TY  - JOUR
T1  - Workforce Diversity and Wait Times to Enter Opioid Treatment
AU  - Erick Guerrero
AU  - Tenie Khachikian
AU  - Yinfei Kong
AU  - Boya Pang
AU  - Daniel Howard
Y1  - 2026/03/05
PY  - 2026
N1  - https://doi.org/10.11648/j.ajhr.20261402.13
DO  - 10.11648/j.ajhr.20261402.13
T2  - American Journal of Health Research
JF  - American Journal of Health Research
JO  - American Journal of Health Research
SP  - 85
EP  - 88
PB  - Science Publishing Group
SN  - 2330-8796
UR  - https://doi.org/10.11648/j.ajhr.20261402.13
AB  - Background: Racial and ethnic minorities face significant disparities in accessing opioid use disorder (OUD) treatment. While workforce diversity is theorized to improve cultural competency, rapport and retention, prior research has yielded mixed results regarding its impact on access, namely wait times. Conversely, workforce diversity may be associated with operational constraints. This study builds on previous work to determine how the association between minority staffing and wait times have changed post-pandemic. Methods: This study analyzes data from the National Drug Abuse Treatment System Survey (NDATSS) for 2017 (n = 101) and 2023 (n = 121) using multilevel linear regression to examine the relationship between staff racial composition and wait times to enter methadone treatment. Results: Consistent with historical trends, higher percentages of African American staff were associated with longer wait times overall. However, a significant interaction with the survey year reveals that this association weakened significantly in 2023 compared to 2017, suggesting a reduction in wait times for programs with diverse staffing in the post-pandemic landscape. Conclusion: The previously observed "cost" of workforce diversity on wait times appears to be diminishing. These findings suggest that evolving organizational practices or policy shifts may be allowing diverse teams to better facilitate timely access to care.
VL  - 14
IS  - 2
ER  -

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Author Information

Erick Guerrero

Research to End Healthcare Disparities Corp, I-Lead Institute, Los Angeles, The United States

Contact Email

http://orcid.org/0000-0003-3086-5710
Tenie Khachikian

Department of Psychological and Brain Sciences, Texas A&M University, College Station, The United States

Contact Email

http://orcid.org/0009-0000-3945-0808
Yinfei Kong

Mihaylo College of Business and Economics, California State University Fullerton, Fullerton, The United States

Contact Email

http://orcid.org/0000-0002-3298-8020
Boya Pang

Department of Psychological and Brain Sciences, Texas A&M University, College Station, The United States

Contact Email

http://orcid.org/0009-0001-0520-4534
Daniel Howard

Department of Psychological and Brain Sciences, Texas A&M University, College Station, The United States

Contact Email

http://orcid.org/0000-0001-7922-3685

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APA Style

Guerrero, E., Khachikian, T., Kong, Y., Pang, B., Howard, D. (2026). Workforce Diversity and Wait Times to Enter Opioid Treatment. American Journal of Health Research, 14(2), 85-88. https://doi.org/10.11648/j.ajhr.20261402.13

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ACS Style

Guerrero, E.; Khachikian, T.; Kong, Y.; Pang, B.; Howard, D. Workforce Diversity and Wait Times to Enter Opioid Treatment. Am. J. Health Res. 2026, 14(2), 85-88. doi: 10.11648/j.ajhr.20261402.13

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AMA Style

Guerrero E, Khachikian T, Kong Y, Pang B, Howard D. Workforce Diversity and Wait Times to Enter Opioid Treatment. Am J Health Res. 2026;14(2):85-88. doi: 10.11648/j.ajhr.20261402.13

Copy | Download

@article{10.11648/j.ajhr.20261402.13,
  author = {Erick Guerrero and Tenie Khachikian and Yinfei Kong and Boya Pang and Daniel Howard},
  title = {Workforce Diversity and Wait Times to Enter Opioid Treatment},
  journal = {American Journal of Health Research},
  volume = {14},
  number = {2},
  pages = {85-88},
  doi = {10.11648/j.ajhr.20261402.13},
  url = {https://doi.org/10.11648/j.ajhr.20261402.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20261402.13},
  abstract = {Background: Racial and ethnic minorities face significant disparities in accessing opioid use disorder (OUD) treatment. While workforce diversity is theorized to improve cultural competency, rapport and retention, prior research has yielded mixed results regarding its impact on access, namely wait times. Conversely, workforce diversity may be associated with operational constraints. This study builds on previous work to determine how the association between minority staffing and wait times have changed post-pandemic. Methods: This study analyzes data from the National Drug Abuse Treatment System Survey (NDATSS) for 2017 (n = 101) and 2023 (n = 121) using multilevel linear regression to examine the relationship between staff racial composition and wait times to enter methadone treatment. Results: Consistent with historical trends, higher percentages of African American staff were associated with longer wait times overall. However, a significant interaction with the survey year reveals that this association weakened significantly in 2023 compared to 2017, suggesting a reduction in wait times for programs with diverse staffing in the post-pandemic landscape. Conclusion: The previously observed "cost" of workforce diversity on wait times appears to be diminishing. These findings suggest that evolving organizational practices or policy shifts may be allowing diverse teams to better facilitate timely access to care.},
 year = {2026}
}

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TY  - JOUR
T1  - Workforce Diversity and Wait Times to Enter Opioid Treatment
AU  - Erick Guerrero
AU  - Tenie Khachikian
AU  - Yinfei Kong
AU  - Boya Pang
AU  - Daniel Howard
Y1  - 2026/03/05
PY  - 2026
N1  - https://doi.org/10.11648/j.ajhr.20261402.13
DO  - 10.11648/j.ajhr.20261402.13
T2  - American Journal of Health Research
JF  - American Journal of Health Research
JO  - American Journal of Health Research
SP  - 85
EP  - 88
PB  - Science Publishing Group
SN  - 2330-8796
UR  - https://doi.org/10.11648/j.ajhr.20261402.13
AB  - Background: Racial and ethnic minorities face significant disparities in accessing opioid use disorder (OUD) treatment. While workforce diversity is theorized to improve cultural competency, rapport and retention, prior research has yielded mixed results regarding its impact on access, namely wait times. Conversely, workforce diversity may be associated with operational constraints. This study builds on previous work to determine how the association between minority staffing and wait times have changed post-pandemic. Methods: This study analyzes data from the National Drug Abuse Treatment System Survey (NDATSS) for 2017 (n = 101) and 2023 (n = 121) using multilevel linear regression to examine the relationship between staff racial composition and wait times to enter methadone treatment. Results: Consistent with historical trends, higher percentages of African American staff were associated with longer wait times overall. However, a significant interaction with the survey year reveals that this association weakened significantly in 2023 compared to 2017, suggesting a reduction in wait times for programs with diverse staffing in the post-pandemic landscape. Conclusion: The previously observed "cost" of workforce diversity on wait times appears to be diminishing. These findings suggest that evolving organizational practices or policy shifts may be allowing diverse teams to better facilitate timely access to care.
VL  - 14
IS  - 2
ER  -

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