One of the most effective therapies for opiate addiction is remains vastly underprescribed in the United States, particularly for Black patients, despite the ongoing increase in opioid overdose fatalities, according to a huge new research.
The study, published in the New England Journal of Medicine on Wednesday, found that despite multiple visits to healthcare providers, only about 20% of patients diagnosed with opioid use disorder actually filled prescriptions for buprenorphine, the medication widely regarded as the gold standard in opioid addiction treatment. Up to 80% more white patients than Black patients and up to 25% more than Latino patients filled their buprenorphine prescriptions within six months after a high-risk event like an overdose, the research showed. Methadone, another successful therapy, was even less often used.
Dr. Barnett, an associate professor at the Harvard T.H. Chan School of Public Health, noted that access to medical care, a factor commonly cited to explain racial differences in treatment, was not necessarily at issue here. There are only two processes remaining that may explain inequalities this enormous,” he added, pointing out that all patients, regardless of race, saw physicians around once a month on average. One is the racial disparity in trust and demand for buprenorphine, and another is the segregation of health care access for persons of colour.
Buprenorphine, sold under the trade name Suboxone, is a synthetic opioid that reduces or eliminates the need for the use of other opioids while also preventing withdrawal symptoms. Although it has been FDA-approved for use in addiction therapy for over two decades, the fact that it is also an opioid means that it is met with scepticism and stigma.
Researchers from the public health departments at Harvard and Dartmouth analysed prescription medication claims submitted to Medicare’s disability programme for the opioid pain reliever buprenorphine. Claims for 23,370 people throughout the country were submitted in the six months after an occurrence in which a healthcare practitioner diagnosed opioid use disorder.
These patients were part of a particularly defenceless group. They met the requirements for Medicare due to a mental health condition or a physical impairment, such as arthritis or back discomfort. Most were also of low enough income to qualify for the Medicaid programme.
No comparison was made between the total number of prescriptions issued and filled by the researchers. In spite of this, the data indicated that prescriptions were being issued far less often than necessary across all ethnic groups: In the research, only 12.7% of Black patients, 18.7% of Latino patients, and 23.3% of white patients got any buprenorphine in the six months after the precipitating incident.
Compared to Latino and white patients, Black patients got fewer supplies at a time and were on the buprenorphine regimen for shorter periods of time.
New York University Grossman School of Medicine adjunct professor and addiction psychiatrist Dr. Ayana Jordan said the findings demonstrated the fruit of many linked challenges in tackling addiction, particularly for Black patients.
She hypothesised that doctors frequently made unconscious assumptions about patients of colour, such as ” ‘They’re not going to participate fully in taking care of themselves, so why go through the motions or take the time, compared to a white patient, to go over everything?’ ”
Dr. Jordan went on to say that doctors frequently fail to adequately explain the necessity of the drug or how to utilise it. She noted that a little co-payment may be necessary even though Medicare and Medicaid covered majority of the Black patients in this research. When a person is already struggling to pay for the basics like food, transportation, and housing, shelling out any amount of money for medication may seem like a luxury. She also said that research has shown that pharmacies stocking such prescriptions are scarce in low-income minority neighbourhoods.
Another worrying conclusion was that participants in the research were more likely to complete prescriptions for drugs known to be fatal for opiate addicts than for treatments that may save their lives. Problematic pharmaceuticals included pain relievers and anti-anxiety meds, both of which, when combined with illicit opioids, may have fatal effects on respiration and blood pressure.
Concerningly, over a quarter of individuals filled prescriptions for opioid medicines despite having previously shown reliance on opioids during medical visits. Prescriptions written for benzodiazepines including Xanax, Valium, and Ativan varied widely by race, ranging from 23.4% among Black patients to 29.6% among Latino patients to 37.1% among white patients.
Previous work on racial differences in abruptly ending addiction treatment has been considerably expanded upon by the present study. It also supports research from the previous month that highlighted the lag in buprenorphine prescriptions despite not just an obvious need but extensive efforts, particularly since the start of the epidemic, to simplify the regulation of doctors who prescribe the medicine.
Involvement in the present study was waived because Dr. Giselle Corbie, a specialist on health equity research at the University of North Carolina School of Medicine, saw the findings as a worrying reflection of problems across the American health system.
