By Lisa Rapaport
(Reuters Health) – While the number of Americans getting drug treatment for opioid addiction is on the rise, a new study suggests that gains may be concentrated among white patients and people who can pay cash or have private health insurance.
Researchers examined nationwide survey data on clinic visits for opioid addiction from 2004 to 2015. Their analysis focused on patients receiving prescriptions for buprenorphine, one of three drugs typically used to treat patients with opioid use disorder.
During the decade-long study period, the proportion of visits when patients got buprenorphine prescriptions rose from 0.04 to 0.36 percent, representing 13.4 million visits from 2012 to 2015, researchers report in JAMA Psychiatry.
Over this period, the proportion of patients who were “self-pay,” meaning they had no insurance for the visits, surged – accounting for more than one-third of patients during the final four years of the study.
After accounting for insurance status and other factors that can impact access to drug addiction treatment, black patients were 77 percent less like to receive buprenorphine prescriptions than white people.
Some of this disparity may be due to buprenorphine being prescribed more often at primary care clinics in more affluent communities with more white and insured residents, said lead study author Dr. Pooja Lagisetty of the University of Michigan School of Medicine in Ann Arbor.
Buprenorphine can lead to breathing problems and other side effects, but it has fewer side effects than methadone, an alternative that is more often available in low-income communities. Buprenorphine has a lower risk of abuse and addiction than methadone, previous studies have found.
And, buprenorphine “can be prescribed in a regular clinic with options for refills,” Lagisetty said by email. “This helps patients be treated in a non-stigmatized environment.”
While the study wasn’t a controlled experiment designed to determine whether or how specific factors might cause racial disparities in addiction treatment, “there may be a component of stigma around the medication that could be different in various racial/ethnic communities,” Lagisetty said.
It’s unclear from the study whether differences in treatment reflect differences in the proportion of white versus black Americans who are suffering from opioid addiction. But some previous research suggests that the prevalence of opioid misuse is similar for both black and white adults, impacting up to about one in 20 people, the study team writes.
“In standard doctors’ offices, when buprenorphine is offered, it’s more often to whites than blacks,” Dr. Stefan Kertesz of the University of Alabama at Birmingham School of Medicine and Birmingham Veterans Affairs Medical Center told Reuters Health by email.
“The results could suggest that the kind of whites who have opioid addiction are just a bit more likely to turn up with that problem in a doctor’s office, while blacks might be a bit less likely to use standard doctor’s offices for that problem,” said Kertesz, who has studied drug policy and opioids but wasn’t involved in the study.
“Blacks with opioid problems have been more concentrated in cities, are often somewhat older, and have been making more use of specialized addiction treatment programs in urban centers,” Kertesz added. “In specialty addiction treatment settings, blacks are actually more likely to receive medication than whites in those same centers.”
SOURCE: http://bit.ly/2JLgMlb JAMA Psychiatry, online May 8, 2019.
