Research has shown people of color are disproportionately impacted by drug overdose deaths and access to treatment is limited. But even if they do find treatment, a new study found white patients receive care for an opioid use disorder longer than Black and Hispanic patients.
Researchers at Harvard Medical School randomly sampled a database looking at prescriptions for buprenorphine – a drug that treats narcotic dependence – from 2006 to 2020. In 2020, they found white patients received treatment for a median of 53 days while Black and Hispanic patients received it for 44 and 35 days, respectively, according to the study published Wednesday in JAMA Psychiatry.
“We wanted to break it down to granular data to really look at what is each patient experience … that way we can help inform policies and improve access,” said study author Huiru Dong, a postdoctoral research associate at Harvard Medical School and Massachusetts. General Hospital.
Buprenorphine, also known by its brand name Suboxone, is a partial opioid agonist that binds to the opioid receptors, according to the National Institute on Drug Abuse. It reduces cravings, withdrawal symptoms, and the sedative effects of other opioids.
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Health experts say it’s recommended that those with opioid use disorders take the drug for at least 180 days. The study, however, showed up to about a quarter of patients made it that long.
“It is very concerning,” said Dr. Denis Antoine, director of the addiction treatment services clinic at Johns Hopkins Bayview Medical Center. He is unaffiliated with the study. “There’s a lot of literature showing that duration of treatment leads to better outcomes. “
While treatment duration for white and black patients has improved Since 2006, the study showed it’s worsened for Hispanic patients. By 2020, duration increased from 47 days to 53 days for white patients and 35 to 44 days for Black patients, but decreased from 40 to 35 days for Hispanic patients.
The randomly selected sample included 11 million prescriptions from more than 240,000 patients, who were 84.1% white, 8.1% Black, 6.3% Hispanic and 1.5% other races and ethnicities.
The lack of racial and ethnic representation in the study is due to inequitable access to treatment, health experts say.
“If it had been another random sample, it would probably look very similar to this one,” said Dr. Silvia Martins, professor of epidemiology and director of the Substance Use Epidemiology Unit at Columbia University Mailman School of Public Health, who is unaffiliated with the study. “It shows that there are few Hispanic and Black patients receiving medication at all.”
Unlike methadone, which is more powerful, buprenorphine does not require patients to visit a clinic every day for treatment because it carries a lower risk of misuse.
That there’s still wide disparities in accessing a drug that can be easily taken on a daily basis is concerning, addiction specialists say, especially as research shows overdose deaths disproportionately impact people of color.
From 2019 to 2020, overdose death rates increased 44% for Black people and 39% for American Indian and Alaska Native people, according to a report from the Centers for Disease Control and Prevention. The study also found the overdose death rate among Black men 65 and older was nearly seven times that of non-Hispanic white men of the same age.
“It builds on prior research that shows there are structural barriers for certain racial, ethnic and marginalized groups for methadone or buprenorphine treatment,” Martins said.
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Some of those barriers include how providers need special training and certification to be able to prescribe buprenorphine. Providers are also capped at how many buprenorphine patients they’re allowed to have depending on how many years they’ve been prescribing.
In addition to breaking down structural barriers, health experts say it is important to improve social determinants of health that affects substance abuse like education, employment and medical care.
Treatment is “not just about the medication,” Antoine said.
“It’s very important that it’s combined with social support, counselling, psychotherapy and even psychiatric help,” he said. “The medication alone is not sufficient but it definitely helps us to stop a person from using, which gives us a chance to address everything else.”
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
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