— Differences emerged despite similar numbers of healthcare visits
Black and Hispanic patients with a disability had a tougher time getting medication to treat opioid use disorder (OUD) despite frequent contact with healthcare providers, Medicare claims data showed.
Within 180 days of an index OUD-related event, Black patients received a prescription for buprenorphine 12.7% of the time, Hispanic patients 18.7% of the time, and white patients 23.3% of the time, reported Michael L. Barnett, MD, of Harvard T. H. Chan School of Public Health in Boston, and colleagues.
Naloxone receipt followed a similar pattern, occurring after 14.4%, 20.7%, and 22.9% of index events, respectively, the authors reported in the New England Journal of Medicine.
Opioid analgesic receipt did not differ across groups, but benzodiazepine receipt occurred after 23.4%, 29.6%, and 37.1% of index events, respectively.
Racial differences in the receipt of medications to treat OUD did not change between 2016 and 2019. Disparities persisted despite similar numbers in ambulatory healthcare visits among Black (6.6), Hispanic (6.7), and white (7.6 visits) patients in the 180-day period.
“White patients filled prescriptions for buprenorphine and naloxone up to 80% more frequently than Black patients and up to 25% more frequently than Hispanic patients following a high-risk OUD-related event,” Barnett told MedPage Today.
“One straightforward hypothesis about why these disparities exist is that Black or Hispanic patients may have fewer healthcare encounters or see fewer doctors,” Barnett added. “We don’t find evidence of this. This suggests that we have to look deeper into which providers are serving minority communities and what patients themselves are looking for. It’s not as simple as just encouraging people to see their local [physician].”
Barnett also noted that patients with OUD frequently received opioids and benzodiazepines at very high rates despite the known risks tied to those drugs. However, the disparity in which patients received those medications across racial groups did not appear to stem from disparities in accessing physicians.
“Addiction has been a separate silo of healthcare for too long and the low quality of care that patients can access is a symptom of this separation, which is itself a consequence of stigma, the driving social force behind so many problems in addiction policy,” Barnett said.
“The current state of OUD treatment is too little appropriate treatment and too much inappropriate, risky prescribing,” he added. “To address inequity in access to OUD treatment, I think all physicians need to become better educated around how to recognize OUD and treat it. If a physician is not comfortable treating OUD, then they should have a place they can refer any patients in need.”
Barnett’s group used Medicare claims data from 2016 to 2019 for a random 40% sample of fee-for-service beneficiaries who were eligible for Medicare due to disability and had a recorded OUD-related event. The time period of the study preceded 2020 Medicare coverage expansion for methadone for OUD, the researchers noted.
The authors defined OUD-related events as opioid overdoses that were treated in an emergency department or inpatient setting, hospitalizations due to an injection drug use-related infection, or rehabilitation or detoxification care with an OUD diagnosis.
They identified 25,904 OUD-related index events among 23,370 beneficiaries, including 19,862 events (76.7%) among white patients, 3,937 (15.2%) among Black patients, and 2,105 (8.1%) among Hispanic patients. About 47% of beneficiaries were female; 88.6% had low-income subsidies, and 81.8% were dually eligible for Medicaid. Drug-use disorder, depression, fibromyalgia, chronic pain, fatigue, and schizophrenia or other psychoses were common co-existing conditions.
Barnett noted that some of the study limitations included a focus on the specific population of disabled Medicare enrollees who are high-risk and disproportionately affected by addiction and overdoses. This focus could mean the results won’t apply more broadly, but they can be valuable as a “diagnostic” check on the status of addiction treatment around the country.
“The state of addiction treatment has never been good in the U.S.,” Barnett observed. “We have made positive strides in the past few years with relaxed regulations for prescribing buprenorphine and telemedicine flexibility. But these are relatively small changes compared to the gaping chasm of need.”