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Another racial disparity in how we address addiction: access to buprenorphine

The growing recognition of the opioid epidemic as a public health emergency, not a criminal or moral one, is a welcome development, but it’s hard not to see a racial component in society’s attitude toward illegal drug use. The crack epidemic in the ‘90s, which largely devastated African American communities, wasn’t treated this way. But now that the face of addiction is increasingly white and suburban or rural, the tone has changed.

And there isn't just a racial disparity in how we talk about addiction, it’s also showing up in how we treat it. New research by the University of Michigan and VA Ann Arbor Healthcare System that recently appeared in JAMA Psychiatry showed that white users addicted to such drugs were 35 times more likely to be prescribed buprenorphine, a drug that curbs the craving for opioids, as a treatment option than African Americans and other people of color. The drug is considered by many in the medical profession as one of the best methods for getting people off drugs and reducing the chance of a overdose.

White patients far more likely to get popular addiction treatment prescription, study finds »

Have we not learned from our past mistakes? Are we once again falling into the same old pattern where the color of one’s skin determines how they are treated by the medical profession? This is an early indication that could be the case if we don’t make some changes.

The researchers, who reviewed 13.4 million medical visits from 2012 to 2015 when buprenorphine was prescribed, found no increase in prescriptions written for African Americans and other minorities.

Economic factors were also likely at play given that the study found that most of those who received the drug were able to pay outright for it or were covered by private insurance that covered the costs. In fact, the number who paid for the drug themselves skyrocketed from 585,568 during the 2004 to 2007 period to 5.3 million from 2012 to 2015. One reason for this may be that few physicians are certified to prescribe the drug, and many of them will only take cash, knocking out a significant part of the population that could benefit from it. Just 25 percent of buprenorphine prescriptions were paid for by Medicare or Medicaid.

The researchers did not provide solutions for bringing more equality to treatment, but it’s not hard to think of some. The first and most important way to expand access is to increase the number of doctors who eligible to prescribe bupe. Right now, just 6 percent of about 1 million physicians in the United States have taken the required training for prescribing buprenorphine, and training isn’t required by residency programs. These doctors can charge a premium like a retailer might with an exclusive product with limited availability. The reimbursement rate of Medicare and Medicaid may also be too low to incentivize these doctors.

It is also worth looking at where doctors who prescribe buprenorphine are located. Is the drug even available in areas where African Americans are seeking care? Is it even given to them as an option?

Whatever the reason, researchers need to delve deeper to figure out why the inequities exist, especially as African Americans are dying from overdoses at a faster rate than whites. The death rate among African Americans from drug overdoses involving fentanyl, the main driver of overdose deaths, increased on average 141 percent each year from 2011 to 2016, according to a Centers for Disease Control study released in March. While there are still more white deaths overall, that could change.

The good news that came out of the latest Maryland overdose numbers released this week was that the state had the slowest growth in deaths since 2011, and some counties even saw declines. Much still needs to be done to stop the epidemic, given that there were still 2,385 overdose total deaths in Maryland last year, an increase of about 5 percent from the year before. It was also the second year in a row that overdose deaths surpassed 2,000.

As the state and country continues to look for ways to end the crisis, addressing racial disparities should be part of the strategy. We cannot create a system where those with means and who are white are able to buy their way to sobriety while an underclass loses their lives.

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