Wide race-based disparities found in use of medications to treat opioid-use disorder

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Despite a rapidly increasing rate of opioid-related deaths, Black Americans are far less likely to receive medical treatment or prescription medications for opioid addiction, a new study finds.

The study’s authors used claims data from 23,370 white, Black and Hispanic Medicare beneficiaries to compare the number of “index events” related to opioid-use disorder (OUD) and the frequency with which the medications most commonly used to treat OUD were prescribed. An index event was defined as a nonfatal overdose treated in an emergency department or inpatient setting, hospitalization due to an injection drug-related infection, or inpatient/residential rehabilitation or detoxification care.

The researchers identified about 26,000 index events, with 15.2% occurring among Black patients, 8.1% among Hispanic patients, and 76.7% among white patients. They found that in the 180 days following an index event, 12.7% of Black patients received buprenorphine, compared to 18.7% for Hispanic patients and 23.3% for white patients.

For naloxone the percentages were 14.4%, 20.7% and 22.9%, respectively, and 23.4%, 29.6% and 37.1% for benzodiazepines. The differences changed little between 2016 and 2019, the years from which the claims were taken.

The authors also examined disparities in health care utilization and outcomes in the 180 days following an index event, a timeframe during which 76% of those experiencing the event have an ambulatory visit with a clinician. The mean number of visits for Black individuals was 6.6, while for Hispanics it was 6.7 and for whites was 7.6. The incidence of overdose was 6.7%, with no apparent differences by race or ethnic group.

The authors note that the disparities are occurring at a time of rapidly-growing opioid mortality among Black Americans. They cite Centers for Disease Control and Prevention (CDC) data showing that opioid-related deaths increased by a factor of 7.7 from 2010 to 2020, a larger increase than any other racial or ethnic group the CDC tracks.

The relatively small differences in ambulatory visits following an index event “challenges the hypothesis that limited care access is a hey driver of racial disparities in the receipt of medications for OUD,” the authors note.

Instead, they point to racism, internalized and external stigma, and other structural factors among both patients and providers as the major causes of the disparities. For patients, they cite lower levels of trust in the safety and effectiveness of OUD medications among Black and Hispanic patients, and the fact that Black and Hispanic patients are less likely than white patients to think they need medication treatment for OUD.

Disparities linked to providers could be the result of low availability of buprenorphine-prescribing primary care providers, bias against using medications to treat OUD for Black and Hispanic patients, or “lack of comfort or confidence in treating OUD…for underserved populations.”

The study, “Racial Inequality in Receipt of Medications for Opioid Use Disorder,” was published in the May 11, 2023 issue of the New England Journal of Medicine.