Anyone can become addicted to opioids. However, a new study finds racial and geographic disparities in who can get buprenorphine.
Buprenorphine is a form of medically assisted treatment, or MAT, used to treat opioid use disorder. It’s more accessible than methadone – it comes in pill form as opposed to a daily trip to the infusion clinic.
Despite recent policies making it easier for doctors to prescribe buprenorphine, Black and Indigenous communities have less access to the medication, said the study’s lead researcher Coleman Drake. His team checked whether people had a prescriber within 30 minutes of them based on all zip codes within the continental United States. Drake is an assistant professor in the School of Public Health at the University of Pittsburgh.
Drake’s findings for rural areas are not surprising – they need more doctors.
“But that wasn’t what we found as much in urban areas. In urban areas, the story was more, ‘There are indeed fewer prescribers and prescribing in more diverse zip codes.’ But there’s really more of a drop in prescribing,” said Drake.
In diverse areas, Drake’s team found that there are 50 percent less prescribers, but nearly 80 percent fewer prescriptions filled. His findings cannot answer why, but he has a few ideas.
“Stigma remains an absolutely huge problem in trying to increase uptake of medications for opioid use disorder,” said Drake. “I think in these urban areas too, there’s the question, ‘Do people have access to insurance? Is the insurance…good?’”
However, Brad Stein said the situation gets even more complicated. He is one of the study’s researchers and is the Director of Opioid Policy, Tools, and Information Center at RAND Corporation. RAND is a global research nonprofit.
Even if patients have insurance, many pay out of pocket, said Stein.
“We do know from secret shopper studies – studies where people…pretend to be patients and call clinicians for appointments – that it’s much easier to get appointments, that some clinicians only accept cash. Some clinicians won’t accept insurance. And that’s more true for buprenorphine than for methadone,” said Stein.
Stein questioned whether policies like that intentionally or unintentionally target people of color.
“But we do know in U.S. society that minoritized individuals tend to be more likely to be socioeconomically disadvantaged. And so, I do think there may be a relationship here with the socioeconomics that this again raises questions about,” said Stein. “There seems to be a difference in where these clinicians are located. And some of that may be racial, to what extent is that related to socioeconomic factors?”
Stein and Coleman Drake ask lawmakers to create policies that remedy disparities between buprenorphine access.
