The study finds that addiction medicine is highly underprescribed, particularly by race


Despite the continuing rise in opioids overdose deaths, A large new study shows that one of the most effective treatments for opioid addiction remains largely underprescribed in the United States, especially for black patients.

From 2016 through 2019, barely more than 20 percent of patients diagnosed with an opioid use disorder filled prescriptions for buprenorphine, the drug considered the gold standard in treating opioid addiction, despite frequent visits to health care providers, according to The study, published Wednesday in the New England Journal of Medicine. The study found that within six months after a high-risk event such as an overdose, white patients filled buprenorphine prescriptions up to 80 percent more often than black patients, and up to 25 percent more often than Hispanic patients. Rates of use of methadone, another effective treatment, were lower overall.

“It was disappointing to see that buprenorphine or methadone treatments were so low, even among patients who had just been discharged from hospital with an overdose or other addiction-related problem,” he said. Dr. Michael L Barnett, lead author, who teaches health policy and management at Harvard University. And not only that, but people of color received the life-saving treatment at a fraction of the rate white patients receive it.

Access to medical care, a reason often used to explain racial disparities in treatment, wasn’t necessarily at work here, said Dr. Barnett, an assistant professor at the Harvard TH Chan School of Public Health. Noting that all patients, regardless of race, saw doctors about once a month, he said, “There are two remaining mechanisms that could explain disparities of this magnitude. One is where people of color get their health care, which we do know.” severe separationand the other is the ethnic differences in Patient confidence and demand to buprenorphine.

Buprenorphine, often marketed under the brand name Suboxone, is a synthetic opioid that satisfies a patient’s cravings for other opioids, preventing withdrawal, without providing a high. It was approved to treat addiction by the Food and Drug Administration more than two decades ago, but it still faces some resistance and stigma because it’s also an opioid.

In the study, researchers from public health programs at Harvard and Dartmouth examined claims made through Medicare’s disability program for prescriptions of buprenorphine and other addiction treatment drugs. The claims, for 23,370 patients nationwide, were submitted during the six months following an episode during which a healthcare provider determined they had an opioid use disorder.

These patients represent a vulnerable population. They have qualified for Medicare because of either a mental or physical disability, usually arthritis or back pain. Most of them were also poor enough to be eligible for Medicaid.

The researchers did not check the number of prescriptions already written and compared them to those filled. But the results indicated that far fewer prescriptions were written than required across all ethnic groups: In the study, only 12.7 percent of black patients received any buprenorphine in the six months following the event, compared with 18.7 percent of Latino patients. and 23.3 percent of Hispanic patients. percent of white patients.

These black patients also received a supply for fewer days at a time, and maintained their buprenorphine regimen for shorter periods, than the Hispanic and white patients.

Dr.. Ayana JordanThe addiction psychiatrist, who teaches at the Grossman School of Medicine at New York University and was not involved in the new research, said that the study showed the result of many intertwined problems in treating addiction, especially for black patients.

She hypothesized that clinicians often make automatic, unconscious assumptions about these patients: ‘They won’t be fully involved in caring for themselves, so why go through the motions or take the time, compared to a white patient, to get through everything?’ “

Dr. Jordan continued that doctors often do not stress the importance of the drug and do not fully explain how to use it. Although most of the black patients in this study were covered by Medicare and Medicaid, those medications can require a modest co-payment, she said. For patients struggling to afford food, transportation, and shelter, spending small cash on medication can be a low priority. She added that studies show that such medicines are often not readily available in pharmacies in poor black communities.

“I don’t want to blame the doctors,” said Dr. Jordan. “I want to blame the system, because it’s a system that encourages limited sharing with patients in general, and it’s a system that’s even more restrictive when you’re dealing with black people.”

In another worrying finding, patients in the study filled prescriptions at higher rates of drugs known to be life-threatening to people addicted to opioids than they filled prescriptions for life-saving medications. Those problematic medications included pain relievers and anti-anxiety medications, which can slow breathing and blood pressure to dangerous levels, especially combined with street opioids.

Nearly a quarter of the patients filled prescriptions for opioid painkillers, a troubling finding because during interviews with doctors they had already indicated their dependence on opioids. Rates of filling prescriptions for benzodiazepines, such as Xanax, Valium, and Ativan, varied by race: 23.4% among black patients, 29.6% among Hispanics, and 37.1% among white patients—all of which far exceeded patients’ acquisition rates for buprenorphine.

“A lot of these patients have chronic pain, for which they are receiving opioids, and they may have mental health comorbidities such as anxiety that they might get the benz,” said Dr. Barnett. Often, these patients end up on more than one controlled substance, sometimes to combat the side effects of another. It’s a complicated mix. But we know for sure that these drugs are a very bad combination together.” The researchers also looked at a separate database of prescriptions filled with methadone, an older prescription drug. From 2020 through 2021, these numbers were also very low across all races, with It ranged from 8 to 11 percent.

The new study expands dramatically previous search On racial differences in addiction treatments ending prematurely. It also complements studies last month That highlighted the delay in prescribing buprenorphine, although there was no clear need just yet great efforts Especially since the onset of the epidemic, to facilitate the regulation of drug providers who prescribe the drug.

Dr. Giselle Corbyan expert in health equity research at the University of North Carolina School of Medicine who was not involved in the current study, called the findings a troubling reflection of the failures throughout the American health system.

“At multiple points along this treatment chain, we’re doing a poor job,” she said. “We need to do a better job of understanding the kinds of support that needs to be given around patients and around the doctors who care for them, to ensure that these preventable deaths are avoided. And so this study, to me, is really the canary in the coal mine.”


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