Decreased Access to Buprenorphine Significantly Affects Minorities with OUD

Thuy Nguyen, PhD

Recent research evaluated the racial and ethnic disparities in buprenorphine and extended-release naltrexone filled prescriptions during the COVID-19 pandemic. Investigators sought to determine if disruptions in these filled prescriptions for opioid use disorder (OUD) during the pandemic differed by race, ethnicity, or insurance status and payer type.

Since the delivery of these treatments were disrupted during the pandemic, members of racial and ethnic minority groups experienced increased risks, not only with the COVID-19 virus, but also surrounding opioid overdose, compared with White individuals. Whether or not filled prescriptions for the drugs varied among racial and ethnic groups was not yet understood.

Investigators, led by Thuy Nguyen, PhD, Department of Health Management and Policy, School of Public Health, University of Michigan, ultimately found that these disparities could have been worsened during the pandemic. Patients of racial and ethnic minority groups experienced more disruptions when filling prescriptions for one of the treatments in order to mitigate OUD, compared with white patients.

Investigating Delivery Disruptions

Retail pharmacy claims from May 2019-June 2021 were evaluated for the cross-sectional study. The Symphony Health database includes 92% of US retail claims and contains data on race, ethnicity across all insurance status and payer categories. Information from individuals was included if buprenorphine and extended-release naltrexone prescriptions were filled.

Investigators identified interrupted time series in order to estimate the levels and trends of dispensed buprenorphine and naltrexone prescriptions before and after the onset of the pandemic. Data were analyzed from July 2021-March 2022.

The weekly rates of the dispensed prescriptions per 1000 patients and proportion of 14 or more days’ supply were calculated for the main outcome of the study. Analyses were stratified by patient race and ethnicity. For White and Black patients, they were further stratified by insurance status and payer type.

The Disparity Data

A total of 1,556,860 individuals filled prescriptions for buprenorphine and 127,506 individuals filled extended-release naltrexone prescriptions within the set timeframe. White individuals represented the stark majority for filling buprenorphine prescriptions (42.7%) as well as naltrexone prescriptions (41.6%). Black individuals represented the second largest proportion with 6.1% and 6.4%, respectively.

While the prepandemic increases in buprenorphine fill rate flattened for all groups after the onset, investigators wrote that extended-release naltrexone had uniform level (from 10.0% for White patients with private insurance; P < .001 to 23.3% for Black patients with Medicare; P < .001) and trend (from 15.5 percentage points for White patients with Medicaid; P = .001 to 52.0 percentage points for Black patients with private insurance; P < .001) decreases across groups.

Medicare and cash-paying patients had a decreased rate of buprenorphine fills but with greater decreases for Black patients (Medicare: 10.0%; P < .001; cash: 20.0%; P < .001) than White patients (Medicare: 3.5%; P = .004; cash: 15.0%; P < .001), according to the study. No decreases were found among Medicaid patients.

Investigators observed that at pandemic onset, there were significant level decreases in buprenorphine fills for members of minority groups, but not for White patients. Black patients experienced a 2.5% level decrease and Hispanic patients had a 4% level decrease.

“This study found that the COVID-19 pandemic was associated with immediate decreases in filled buprenorphine prescriptions by members of racial and ethnic minority groups but not White individuals,” investigators concluded. “These findings suggest that members of racial and ethnic minority groups had larger losses in buprenorphine access during the pandemic across payer types.”

The study, "Racial and ethnic disparities in buprenorphine and extended-release naltrexone filled prescriptions during the COVID-19 pandemic," was published in Jama Network.