by Dennis Thompson
HealthDay Reporter
THURSDAY, May 11, 2023 (HealthDay News) — Drugs that treat opioid addiction and prevent overdose deaths are underprescribed in the United States, particularly for black patients, a new study found.
Disabled people with Medicare are unlikely to be prescribed buprenorphine, the best drug for treating opioid addiction, or naloxone (Narcan), a drug that can reverse a life-threatening overdose, researchers report in the 10th issue of May of the New England Journal of Medicine.
In addition, African-Americans are even less likely than whites to receive these drugs after a medical event that clearly indicates that the patient has an opioid use disorder, said lead researcher Dr. Michael Barnett, an associate professor of politics and health management at the Harvard TH Chan School. of Public Health in Boston.
“We found that white patients were 80% more likely to receive any treatment after one of these core events than black patients,” Barnett said. “We were especially surprised by how low the treatment rates were, given the high level of need and high risk in this particular population.”
For the study, Barnett and his colleagues analyzed claims data from more than 23,000 disabled people ages 18 and older covered by Medicare between 2016 and 2019.
This group is disproportionately affected by opioid addiction, and some estimates suggest they account for one in four opioid overdoses in the United States, the researchers noted in background notes.
The researchers looked for events that would have brought a person’s opioid use disorder to the attention of a health professional: an overdose, a hospitalization for a drug-related infection, or detoxification care, for example.
They then assessed whether the patient received a prescription for buprenorphine or naloxone within six months of that event.
Results showed that only 23% of white patients, 19% of Hispanic patients, and 13% of black patients received a buprenorphine prescription.
Buprenorphine is “a drug that is known to be quite effective, and yet in the populations identified in the study, the prescription rates are quite abysmal overall,” said Christine Khaikin, a senior health policy attorney at Legal Action. Center, an advocacy group. for the construction of equity in health.
The rates were similarly low for naloxone: 23% for whites, 21% for Hispanics, and 14% for blacks.
Buprenorphine prescription rates may have decreased due to regulations at the time restricting who could prescribe the treatment drug, Barnett noted. Those restrictions were recently lifted.
But for naloxone, “which has no such restrictions at all, we saw disparities of basically the exact same magnitude,” Barnett said. “There is no reason why doctors should not prescribe this drug to people who overdose, yet we did see a large gap between blacks and whites.”
“And not only that, although there is a big difference between whites and blacks, the overall rates of people receiving buprenorphine or naloxone were extremely low,” Barnett added.
What’s worse, patients identified with opioid addiction were more likely to be prescribed benzodiazepines, drugs typically used to treat anxiety that can dramatically increase the risk of overdose when used with opioids.
About 37% of whites, 30% of Hispanics and 23% of blacks were prescribed benzodiazepines within six months of an opioid-related health event, the results show.
The researchers ruled out regional differences and patient access to care as possible explanations for the health disparities they discovered, Barnett said.
“What we found here was that, unsurprisingly in a fairly ill population of people with disabilities, white, black, and Hispanic patients were seeing doctors quite frequently, including emergency visits and office visits with primary care providers. and mental health.” Barnett said. “Yet you’re still seeing this huge disparity.”
One possible explanation could be the disjointed nature of American health care, Barnett said. She noted that a recent VA health system study found much less disparity between blacks and whites in opioid addiction treatment, on the order of 42% vs. 39%.
“To me, that suggests that maybe there is something about the consistency and shared providers used by veterans that might be more of an equalizer than the very fragmented and segregated health care system that whites and blacks interact with in other settings. Barnett said.
The stigma surrounding opioid addiction could also be a factor, Barnett said.
“There is an enormous amount of stigma around opioid use disorder that makes providers uninterested in treating these patients and makes patients feel like they don’t deserve treatment or don’t want to tell others about it,” Barnett said.
The criminalization of addiction through the US war on drugs added to that stigma, Khaikin said. Blacks are less likely to trust doctors and seek care because there is a real risk that they will end up behind bars.
“There is likely to be a criminal response to people of color experiencing opioid use disorder,” Khaikin said. “We are still treating people with substance use disorders with a criminal response, and that needs to change.”
The United States needs to drastically rethink its approach to opioid use disorder, treating it as an illness rather than a crime or a weakness of character, Barnett said.
“Health care providers need to feel that addiction is very common and that it’s something they should be able to treat,” Barnett said. “It’s part of what it means to be a doctor. It’s not someone else’s job.”
The National Institute on Drug Abuse and the National Institute on Aging funded the study.
More information
The US National Institute on Drug Abuse has more about effective opioid addiction treatments.
SOURCES: Michael Barnett, MD, associate professor, health policy and management, Harvard TH Chan School of Public Health; Christine Khaikin, Senior Health Policy Attorney, Center for Legal Action; New England Journal of MedicineMay 10, 2023
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