Despite continued growth in opioid use death from overdose One of the most effective treatments for opioid addiction continues to be grossly underestimated in the United States, especially for black patients, according to a major new study.

From 2016 to 2019, barely more than 20 percent of patients diagnosed with an opioid use disorder filled prescriptions for buprenorphine, considered the gold standard in the treatment of opioid dependence, despite repeated visits to healthcare providers. the study, which was published Wednesday in the New England Journal of Medicine.. The study found that within six months of a high-risk event such as an overdose, white patients were 80 percent more likely to write buprenorphine prescriptions than black patients and 25 percent more likely than Hispanic patients. The use of methadone, another effective treatment, was generally even lower.

“It was depressing to see that buprenorphine or methadone treatment was so low, even among patients who had just left the hospital with an overdose or other addiction-related problem,” he said. Dr. Michael L. Barnett, lead author teaching health policy and management at Harvard. “Not only that, people of color received life-saving treatment several times less often than white patients.”

Access to health care is a reason often used to explain racial disparities in treatment – which was not necessarily the case here, the doctor said. Barnett, Associate Professor, Harvard T. H. Chan School of Public Health. Noting that all patients, regardless of race, met with doctors about once a month, he said: “There are two mechanisms left that could explain such a large disparity. One of them is a place where people of color get medical care. highly segregatedand the other is racial differences in patient trust and demand for buprenorphine.

Buprenorphine, often sold under the brand name Suboxone, is a synthetic opioid that satisfies a patient’s cravings for other opioids and prevents withdrawal without causing intoxication. It was approved for addiction treatment by the Food and Drug Administration over two decades ago but still faces some resistance and stigma because it is also an opioid.

In the study, researchers from public health programs at Harvard and Dartmouth examined applications filed under the Medicare Disability Program for prescriptions for buprenorphine and other addiction drugs. Lawsuits from 23,370 patients across the country were filed within six months of the episode during which a healthcare professional determined they had an opioid use disorder.

These patients represented a vulnerable population. They were eligible for Medicare either because they were mentally handicapped or because of a physical disability, usually arthritis or back pain. Most of them were also poor enough to be eligible for Medicaid.

The researchers did not examine the number of prescriptions actually written and did not compare them with those that were written. But the results showed far fewer prescriptions were written across all racial groups than required: in the study, only 12.7% of black patients received any buprenorphine within six months of the triggering event, compared with 18.7% of Hispanic and Hispanic patients. 23.3%. percent of white patients.

These black patients also received fewer day’s supplies and maintained their buprenorphine regimen for a shorter period of time than Hispanic and white patients.

Dr. Ayana JordanAn addiction psychiatrist who teaches at New York University’s Grossman School of Medicine and was not involved in the new study said the study showed the result of many interconnected problems in dealing with addiction, especially for black patients.

She suggested that physicians often make automatic, unconscious assumptions about such patients: “They are not going to be fully involved in self-care, so why make any movements or waste time, compared to a white patient, for everything? ‘ ”

Doctors often do not emphasize the importance of the medicine and do not fully explain how to use it. Jordan continued. Even though the majority of black patients in this study were covered by Medicare and Medicaid, those drugs may require a modest co-pay, she said. For patients who struggle to afford food, transportation, and shelter, even small cash outlays on medications can be secondary. And, she added, studies show that such drugs are not always readily available from pharmacies in poorer communities of color.

“I don’t want to blame the doctors,” the doctor said. Jordan said. “I want to blame the system because it encourages limited interaction with patients in general, and even more limited when you’re dealing with blacks.”

Another finding of concern is that patients in the study were more likely to write prescriptions for drugs known to be life-threatening for opioid dependent people than they were to write prescriptions for life-saving drugs. These problematic medications included painkillers and anti-anxiety drugs, which, especially when combined with street opioids, can slow breathing and blood pressure to dangerous levels.

Nearly a quarter of the patients wrote prescriptions for opioid painkillers, which was a problem as they had already indicated opioid addiction during meetings with doctors. Prescription rates for benzodiazepines such as Xanax, Valium, and Ativan differed by race: 23.4 percent in black patients, 29.6 percent in Hispanics, and 37.1 percent in white patients—all of which far exceeded those on buprenorphine. patients.

“Many of these patients suffer from chronic pain for which they take opioids, and they may have comorbid psychiatric illnesses such as anxiety, for which they may receive benzos,” says the doctor. Barnet said. “Very often, these patients receive more than one controlled substance, sometimes to counteract the side effects of another. It’s a complex mixture. But we know for sure that these drugs are a very bad combination.” The researchers also looked at a separate database of prescriptions for methadone, an older medication. From 2020 to 2021, those numbers were also very low for all races, between 8 and 11 percent.

The new study greatly expands on previous research on racial differences in prematurely terminated addiction treatment. It also complements Research last month this indicated a delay in prescribing buprenorphine, despite not only a clear need, but also significant effort especially with the onset of the pandemic, to ease the regulation of prescribers.

Dr. Gisele 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 results a disturbing reflection of the failure of the entire American healthcare system.

“At many stages of this treatment cascade, we are not doing well,” she said. “We need to better understand what support needs to be given to patients and the doctors who care for them in order to prevent these preventable deaths. And so this study is really a canary in a coal mine for me.”