Study Finds Addiction Medications Are Significantly Underprescribed, Especially By Race

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 to treat addiction over 20 years ago, it still faces 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 represent a vulnerable population. They qualified for Medicare because of a mental or physical disability, usually arthritis or back pain. Most were also poor enough to qualify for Medicaid.

The researchers didn’t look at the number of prescriptions actually made and compare it with the number of prescriptions actually 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 don’t emphasize the importance of the drug or adequately explain how to use it. Most black patients in the study were covered by Medicare and Medicaid, but these drugs may require moderate out-of-pocket costs, she said. Even small medical expenditures can become a low priority for patients who are struggling to manage their health. And studies show that such drugs are often not readily available at pharmacies in poorer communities of color.

“I don’t want to blame the doctor,” 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 slow breathing and blood pressure to dangerous levels, especially when used with street opioids.

Nearly a quarter of patients filled out prescriptions for opioid pain relievers, a troubling result because they had already indicated opioid dependence at the time of their doctor’s appointment. Prescription rates for benzodiazepines such as Xanax, Valium, and Ativan vary by race, with 23.4% in black patients, 29.6% in Latinos, and 37.1% in white patients, all of which significantly reduce patient acquisition rates of buprenorphine. It exceeded.

“Many of these patients have chronic pain, are on opioids for it, and may have mental health comorbidities such as anxiety that may be on benzos.” Dr. Barnett said. “Very often these patients end up taking multiple controlled substances, sometimes offsetting the side effects of another substance. I’m sure.” The researchers also looked at another database of prescriptions for the old drug methadone. From 2020 to 2021, these numbers were very low across all races, in the range of 8-11%.

New research greatly expands previous research On racial disparities in discontinued addiction treatment.it also complements study last month Not only is there a clear need considerable effort especially since the outbreak of the pandemic, to ease regulations on providers who prescribe drugs.

Dr. Giselle CoveyA health equity research expert at the University of North Carolina School of Medicine, who was not involved in the current study, described the results as an alarming reflection of the failure of America’s healthcare system as a whole.

“At multiple points along this therapeutic cascade, we are doing a poor job,” she said. We need to have a better understanding of the types of support that need to be placed around clinicians who are caring for.