Friday, May 10, 2019

Blacks, Minorities Far Less Likely to Receive Buprenorphine Treatment for OUD

There are stark racial and economic divides in access to treatment for opioid use disorder (OUD): In fact, whites were roughly four times more likely to receive a prescription for buprenorphine during an outpatient visit from 2012 to 2015, compared with blacks or other racial or ethnic minorities, according to a study published in JAMA Psychiatry.

“We shouldn’t see differences this large, given that people of color have similar rates of opioid use disorder,” said lead author Pooja A. Lagisetty, M.D., M.Sc., an assistant professor in the Division of General Medicine at the University of Michigan, in a press release. “As the number of Americans with opioid use disorder grows, we need to increase the access to treatment for black and low-income populations and be thoughtful about how we reach all those who could benefit from this treatment.”

Lagisetty and colleagues studied data collected from two nationally representative surveys of non-federally employed physicians from 2004 to 2015. These surveys tracked the medications prescribed by physicians during each outpatient office visit, patient demographic information, and expected source of payment. The researchers examined only buprenorphine-related visits and broke the data into three study periods: 2004-2007, 2008-2011, and 2012-2015.

The researchers found that there has been growth in the use of buprenorphine for OUD: In 2004, just 0.04% percent of all outpatient visits included a prescription for the partial opioid agonist and by 2015, the buprenorphine prescription rate had risen nine times, to 0.36% of all ambulatory visits. Despite studies showing the prevalence of opioid misuse is similar for black (3.5%) and white (4.7%) adults, the researchers found that buprenorphine was prescribed almost exclusively at visits by white patients.

Among visits associated with buprenorphine during 2012-2015, 95% were by whites, 2.7% were by blacks, and 2.4% were by other racial/ethnic minorities.

“I was surprised that while there has been overall growth in treatment, this has been largely concentrated in white populations,” Lagisetty told Psychiatric News. “Most of these visits are paid for by cash and private insurance, which could be a major barrier for individuals with low financial resources.” Cash-only buprenorphine clinics have proliferated in recent years, which expand access only for those with the means to pay, she added.

Patients paid out of pocket for nearly 40% of buprenorphine-related outpatient visits from 2012 to 2015, a figure which has held steady throughout the study period despite changes in national health insurance law requiring equal coverage of mental health and substance use care a decade ago. Private insurance picked up the tab for nearly 34% of such visits, a sharp rise from just under 20% in 2004-2007. Meanwhile, public insurance programs Medicaid and Medicare paid for just 19% of the visits (a drop from 32% in 2004-2007).

For more information, see the Psychiatric News article “How the Opioid Addiction Crisis Was Rendered ‘White.’

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