Racial Differences in Opioid Addiction Treatment

A recent study of buprenorphine prescription rates has found that white patients were significantly more likely to receive a prescription than black patients.

Investigators from the University of Michigan examined prescriptions between 2004 and 2015 and found that, despite a similar prevalence of opioid use, black patients were less likely to receive a buprenorphine prescription from doctors.

Investigators combined data obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey outpatient department component from 2004 to 2015. They noted these surveys were chosen because they provided a nationally representative estimate of ambulatory care provided in the United States and captured data related to the medications prescribed during each visit, expected source of payment, and patient demographics.

Authors wrote that buprenorphine was chosen because it is 1 of 3 evidence-based medication for treating opioid use disorder and can be legally prescribed in office-based settings.

Investigators limited their sample to visits when buprenorphine was prescribed and data was aggregated into 4-year periods. They chose 2012-2015, due to its recency, to examine the association not race and ethnicity with receipt of buprenorphine prescriptions.

Investigators found that the rate of buprenorphine visits skyrocketed from 0.04% to 0.36% of all ambulatory visits from 2004 to 2015. Additionally, between 2012 and 2015, 13.4 million visits took place. White patients received buprenorphine at more visits than patients of other races and ethnicities (12.7 million (95% CI, 8.6 million-16.8 million) versus 363,000 (95% CI, 134,000-594,000)).

Self-payment and private insurance were the most common methods for payment across all study years. The amount of self-pay patients increased sharply from 585,568 visits in 2004 to 5.3 million visits in 2012 to 2015, which accounts for 39.6% of all visits during the period.

After adjusting for sex, age, and payment method, investigators found that black patients had statistically significant lower odds (adjusted odds ratio, 0.23; 95% CI, 0.13-0.44) of reaching buprenorphine at their visits compared to white patients. Despite increases in prescription rates nationwide, investigators found that the percentage of those visits where the patients were black fell over the course of the study period.

In their discussion, investigators wrote they hoped the study could serve as a snapshot of the national differences in buprenorphine treatment for opioid use disorder and urged for policy and research to specifically address racial, ethnic, and economic differences in treatment access and engagement.

“We shouldn’t see differences this large, given that people of color have similar rates of opioid use disorder,” said Pooja Lagisetty, MD, MSc, lead author and opioid researcher at the Ann Arbor VA Hospital. “As the number of Americans with opioid use disorder grows, we need to increase access to treatment for black and low-income populations, and be thoughtful about how we reach all those who could benefit from this treatment.”

This study, titled “Buprenorphine Treatment Divide by Race/Ethnicity and Payment”, was published in JAMA Psychiatry.