Addiction Treatment Medicine Is Vastly Underprescribed, Especially by Race, Study Finds

Despite continued rise in opioids death from overdose, One of the most effective treatments for opioid addiction is still largely underprescribed in the United States, especially for black patients, according to a large new study.

Between 2016 and 2019, more than 20% of patients diagnosed with opioid use disorders rarely filled a prescription for buprenorphine. A study published Wednesday in the New England Journal of MedicineWithin 6 months of a high-risk event such as an overdose, white patients filled up to 80% more buprenorphine prescriptions than black patients and up to 25% more than Latino patients. Use of methadone, another effective treatment, was generally even lower.

“It is disappointing to see that buprenorphine or methadone treatment is so low, even among patients who have just been discharged from the hospital with an overdose or other addiction-related problems.” Dr. Michael L. Burnett, lead author who teaches health policy and management at Harvard. “Not only that, but a smaller percentage of people of color received life-saving treatment than white patients.”

Access to healthcare, a commonly used reason to explain racial disparities in treatment, didn’t always work here, says Dr. Burnett, an associate professor at the Harvard TH Chan School of Public Health. Noting that every patient, regardless of race, had at least one doctor’s visit nearly every month, he said, “There are two mechanisms that remain for him that could explain such a large disparity. , where people of color receive health care. highly isolatedand another is racial differences Patient trust and demand for buprenorphine. ”

Buprenorphine, often marketed under the brand name Suboxone, is a synthetic opioid that satisfies patients’ cravings for other opioids and prevents withdrawal without providing a high sensation. Although it was approved by the Food and Drug Administration as an addiction drug more than 20 years ago, it is still subject to resistance and stigma because it is also an opioid.

In this study, researchers from the Public Health Program at Harvard and Dartmouth College examined claims filed through Medicare’s Disability Program for prescriptions for buprenorphine and other addiction medications. Claims against her 23,370 patients nationwide were filed in the six months following an episode that providers determined was an opioid use disorder.

These patients represented a vulnerable population. They were eligible for Medicare because of mental health problems or physical disabilities such as arthritis or back pain. Most were also poor enough to qualify for Medicaid.

The researchers did not look at the number of prescriptions actually written and compare it with the number of prescriptions filled. However, findings suggest that far fewer prescriptions are written than required across all racial groups. , only 12.7% of black patients received buprenorphine compared to white patients.

These black patients received fewer days at a time and maintained buprenorphine therapy for a shorter duration than Latino and Caucasian patients.

Dr. Ayana JordanAn addiction psychiatrist teaching at the NYU Grossman School of Medicine, he was not involved in the new research.

She theorized that doctors often unconsciously automatically make assumptions about such patients. all? ‘ ‘

Dr. Jordan continued, doctors often do not emphasize the importance of drugs or adequately explain how to use them. Most black patients in the study were eligible for Medicare and Medicaid, but these drugs can require moderate out-of-pocket costs, she said. Even small cash outlays for medicines may be a low priority for patients who are And studies show that such drugs are often not readily available at pharmacies in poorer communities of color, she added.

“I don’t want to blame the doctors,” Dr. Jordan said. “I like to blame the system because it promotes limited engagement with patients overall, and is even more limited when dealing with black people.”

In another finding that raises concern, patients in this study were more likely to fill prescriptions for drugs known to be life-threatening for opioid addicts than to fill prescriptions for life-saving drugs. These problematic drugs include pain relievers and anti-anxiety drugs, which can cause breathing and blood pressure to drop to dangerous levels, especially when used with over-the-counter opioids.

Nearly a quarter of the patients filled out prescriptions for opioid pain relievers, with troubling results because they had already indicated opioid dependence during their doctor’s appointments. Prescription acceptance rates for benzodiazepines such as Xanax, Valium, and Ativan vary by race, with 23.4 percent in black patients, 29.6 percent in Latinos, and 37.1 percent in white patients, all of which far exceed patient uptake of buprenorphine. was

“Many of these patients have chronic pain for which they are on opioids, and may have mental health comorbidities such as anxiety, for which they are on benzos. It’s possible,” Barnett said. “These patients often end up taking multiple controlled substances, possibly to counter the side effects of another controlled substance. It’s a complex mix. But the combination of these drugs is very It’s certainly bad.” The researchers also looked at another database of filled prescriptions for the old drug methadone. From 2020 to 2021, these figures were very low across all races, ranging from 8 to 11 percent.

This new study significantly expands on previous research on racial disparities in discontinued addiction treatment.I will also complement study last month This highlighted the delay in prescribing buprenorphine as well as a clear need. considerable effort especially since the outbreak of the pandemic, to ease regulations on providers who prescribe drugs.

Dr. Giselle CoveyAn expert in health equity research at the University of North Carolina School of Medicine, who was not involved in the study, said the results were a worrying reflection of the failure of America’s healthcare system as a whole.

“At multiple points in this course of treatment, we are doing a poor job,” she said. “We need a better understanding of what support we need to provide around patients and around the clinicians who care for them to ensure that these preventable deaths are avoided.” So for me this research is really the canary in the coal mine.”

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