By Dennis Thompson
health day reporter
THURSDAY, May 11, 2023 (HealthDay News) — Drugs that treat opioid addiction and prevent overdose deaths are significantly under-prescribed in the United States, especially for black patients, according to a new study.
People with disabilities on Medicare are unlikely to be prescribed buprenorphine – the best drug for treating opioid addiction – or naloxone (Narcan), a drug that can reverse a life-threatening overdose, researchers report in the issue of May 10 from New England Journal of Medicine.
Additionally, black Americans are even less likely than whites to receive these drugs following a medical event that clearly indicates the patient has an opioid use disorder, the lead researcher said. , Dr. Michael Barnett, Associate Professor of Health Policy and Management at Harvard TH Chan School. of public health in Boston.
“We found that white patients were about 80% more likely to receive treatment after one of these central events than black patients,” Barnett said. “We were particularly surprised at the low treatment rates, given the high level of need and high risk in this particular population.”
For the study, Barnett and his colleagues analyzed claims data for more than 23,000 people with disabilities ages 18 and older covered by Medicare between 2016 and 2019.
This group is disproportionately affected by opioid addiction, with some estimates suggesting they account for one in four opioid overdoses in the United States, researchers said in briefing notes.
The researchers looked for events that would have brought a healthcare professional’s attention to a person’s opioid use disorder – an overdose, hospitalization for a drug use-related infection, or detoxification, for example.
They then assessed whether the patient had received a prescription for buprenorphine or naloxone within six months of this event.
The results showed that only 23% of white patients, 19% of Hispanic patients, and 13% of black patients were prescribed buprenorphine.
Buprenorphine is “a drug known to be quite effective, and yet in the populations identified in the study, prescribing rates are generally quite abysmal,” said Christine Khaikin, senior health policy attorney for the Legal Action Center, an advocacy group. to strengthen health equity.
Rates were similarly low for naloxone – 23% for whites, 21% for Hispanics, and 14% for blacks.
Buprenorphine prescription rates could have been mitigated by regulations that at the time restricted who could prescribe the treatment drug, Barnett noted. These restrictions were recently lifted.
But for naloxone, “which has no such restrictions at all, we saw disparities of essentially the same magnitude,” Barnett said. “There’s no reason clinicians shouldn’t prescribe this drug to people with overdoses, but we’ve seen a huge gap between whites and blacks.”
“And not only that, even though there is a big gap between whites and blacks, the overall rates of people receiving buprenorphine or naloxone were extremely low,” Barnett added.
Worse still, patients identified as having an opioid addiction were more likely to be prescribed benzodiazepines – drugs typically used to treat anxiety that can significantly increase the risk of overdose when used with opioids.
About 37% of whites, 30% of Hispanics and 23% of blacks were prescribed benzodiazepines within six months of an opioid-related health event, according to the results.
The researchers ruled out regional differences and patient access to medical care as potential explanations for the health inequalities they found, Barnett said.
“What we found here is that, as one would expect in a fairly ill disabled population, white, black, and Hispanic patients were all seeing physicians fairly frequently, including emergency visits. and office visits with mental health and primary care providers,” Barnet says. “Yet you still see this huge disparity.”
One potential explanation could be the disjointed nature of American health care, Barnett said. He noted that a recent study by the VA Health System found much less disparity between whites and blacks in opioid addiction treatment — on the order of 42% versus 39%.
“To me, that suggests there may be something about the consistency and shared providers used by veterans that might be more of an equalizer than the very fragmented and segregated health care system with which whites and black people engage in other contexts,” Barnett said.
Stigma surrounding opioid addiction may also play a role, Barnett said.
“There’s just a huge amount of stigma around opioid use disorder that makes providers indifferent to treating these patients and makes patients feel like they don’t deserve treatment or don’t want to. not tell others about it,” Barnett said.
The criminalization of addiction through the US Drug War has added to that stigma, Khaikin said. Black people are less likely to trust doctors and seek treatment because there is a real risk that they will end up behind bars.
“There will likely be a criminal response to people of color who suffer from opioid use disorder,” Khaikin said. “We still treat people with substance use disorders with a criminal response, and that needs to change.”
The United States needs to radically rethink its approach to opioid use disorder, treating it like a disease rather than a crime or character weakness, Barnett said.
“Health care providers need to feel that addiction is very common and something they should be able to treat,” Barnett said. “That’s part of what it means to be a clinician. It’s not someone else’s job.
The National Institute on Drug Abuse and the National Institute on Aging funded the study.
The US National Institute on Drug Abuse has more to say about effective treatments for opioid addiction.
SOURCES: Michael Barnett, MD, associate professor, health policy and management, Harvard TH Chan School of Public Health; Christine Khaikin, Senior Health Policy Advocate, Center for Legal Action; New England Journal of MedicineMay 10, 2023