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Black patients with opioid use disorder were far less likely to fill prescriptions for the most effective addiction treatments than white patients. But strikingly few patients of all races got the medicine.
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By Jan Hoffman
Despite the continuing rise in opioid overdose deaths, one of the most effective treatments for opioid addiction is still drastically underprescribed in the United States, especially for Black patients, according to a large new study.
From 2016 through 2019, scarcely more than 20 percent of patients diagnosed with opioid use disorder filled prescriptions for buprenorphine, the medication considered the gold standard in opioid addiction treatment, despite repeated visits to health care providers, according to the study, which was published Wednesday in the New England Journal of Medicine. Within six months following a high-risk event like an overdose, white patients filled buprenorphine prescriptions up to 80 percent more often than Black patients, and up to 25 percent more often than Latino patients, the study found. Rates of use for methadone, another effective treatment, were generally even lower.
“It was disheartening to see that buprenorphine or methadone treatments were so low, even among patients who just left the hospital with an overdose or other addiction-related issue,” said Dr. Michael L. Barnett, the lead author, who teaches health policy and management at Harvard. “And not only that, but people of color received lifesaving treatment at a fraction of the rate that white patients did.”
Access to medical care, a reason often used to explain racial disparities in treatment, was not necessarily at work here, said Dr. Barnett, an associate professor at the Harvard T.H. Chan School of Public Health. Noting that all the patients regardless of race encountered doctors roughly once a month, he said, “There are two mechanisms left that could explain disparities this large. One is where people of color get their health care, which we know is highly segregated, and another is racial differences in patient trust and demand for buprenorphine.“
Buprenorphine, often marketed under the brand name Suboxone, is a synthetic opioid that satisfies a patient’s cravings for other opioids and prevents withdrawal, without providing a high. It was approved for addiction treatment by the Food and Drug Administration more than two decades ago, but still faces some resistance and stigma because it, too, is an opioid.
In the study, researchers from public health programs at Harvard and Dartmouth examined claims filed through Medicare’s disability program for prescriptions of buprenorphine and other addiction treatment drugs. The claims, for 23,370 patients nationwide, were filed during the six months following an episode during which a health care provider had determined they had opioid use disorder.
These patients represented a vulnerable population. They qualified for Medicare either because of a mental health disability or a physical one, typically arthritis or back pain. Most were also poor enough to be eligible for Medicaid.
Researchers did not examine the number of prescriptions actually written and compare them to those that were filled. But the findings suggested that far fewer prescriptions were being written than were needed across all racial groups: In the study, only 12.7 percent of Black patients received any buprenorphine in the six months after the precipitating event, compared with 18.7 percent of Latino patients and 23.3 percent of white patients.
Those Black patients also received supplies for fewer days at a time, and maintained the buprenorphine regimen for shorter durations, than Latino and white patients.
Dr. Ayana Jordan, an addiction psychiatrist who teaches at the N.Y.U. Grossman School of Medicine and was not involved in the new research, said the study showed the result of many intertwined problems in addressing addiction, especially for Black patients.
She theorized that often physicians made automatic, unconscious assumptions about such patients: “ ‘They’re not going to participate fully in taking care of themselves, so why go through the motions or take the time, compared to a white patient, to go over everything?’ ”
Doctors often don’t emphasize the importance of the medication nor fully explain how to use it, Dr. Jordan continued. Even though most Black patients in this study were covered by Medicare and Medicaid, these medications can require a modest co-payment, she said. For patients struggling to afford food, transportation and shelter, even a small cash outlay for medicine can be a low priority. And, she added, studies show that such medications are not often readily available at pharmacies in poorer communities of color.
“I don’t want to blame doctors,” Dr. Jordan said. “I want to blame the system, because it’s one that promotes limited engagement with patients overall, one that’s even more limited when you’re dealing with Black people.”
In another finding causing concern, patients in the study filled prescriptions at higher rates for medications known to be life-threatening for people addicted to opioids than they filled prescriptions for the lifesaving medicines. Those problematic medications included painkillers and anti-anxiety drugs which, particularly in conjunction with street opioids, can slow breathing and blood pressure to dangerous levels.
Nearly a quarter of the patients filled prescriptions for opioid painkillers, a troubling finding because during encounters with doctors they had already indicated a dependence on opioids. Rates of filled prescriptions for benzodiazepines, like Xanax, Valium and Ativan, differed by race: 23.4 percent among Black patients, 29.6 percent among Latinos and 37.1 percent of white patients — all of which far exceeded rates of the patients’ acquisition of buprenorphine.
“A lot of these patients have chronic pain, for which they are receiving opioids, and they might have mental health comorbidities like anxiety that they might be getting benzos for, ” Dr. Barnett said. “Very often these patients will end up with more than one controlled substance, sometimes to counteract side effects from another. It’s a complex mix. But we know for sure that these meds are a very bad combination together.” The researchers also looked at a separate database of prescriptions filled for methadone, an older treatment medication. From 2020 through 2021, those numbers were also very low across all races, ranging from 8 to 11 percent.
The new study greatly expands upon earlier research about racial disparities in prematurely terminated addiction treatments. It also complements studies last month that underscored the lag in buprenorphine prescriptions, despite not only a clear need but considerable efforts , especially since the onset of the pandemic, to ease the regulation of providers who prescribe the medication.
Dr. Giselle Corbie, an expert on health equity research at the University of North Carolina School of Medicine who was not involved in the current study, described the results as a worrisome reflection of failures throughout the American health system.
“At multiple points along this cascade of treatment we are doing a poor job,” she said. “We need to be doing a better job of understanding the kinds of supports that need to be put around patients and around the clinicians that are caring for them, to ensure that these preventable death are averted. And so this study, to me, really is the canary in the coal mine.”
Jan Hoffman writes about behavioral health and health law. Her wide-ranging subjects include opioids, tribes, reproductive rights, adolescent mental health and vaccine hesitancy. @JanHoffmanNYT
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FAQs
Addiction Treatment Medicine Is Vastly Underprescribed, Especially by Race, Study Finds? ›
Addiction Treatment Medicine Is Vastly Underprescribed, Especially by Race, Study Finds. Black patients with opioid use disorder were far less likely to fill prescriptions for the most effective addiction treatments than white patients. But strikingly few patients of all races got the medicine.
Which medication treatment for addiction is shorter for black and hispanic patients? ›Black and Hispanic patients with opioid use disorder complete shorter durations of buprenorphine treatment compared with white patients, while the disparity has widened in recent years, according to results of a new study.
What is the most effective treatment for substance use disorder? ›Cognitive behavioral therapy (CBT): CBT is a one-on-one therapy during which you meet privately with a therapist over a period of time. It's often considered the most effective therapy for drug and alcohol use disorders.
What are some evidence based interventions for substance abuse? ›- Motivational Interviewing.
- Cognitive Behavioral Therapy.
- Brief Treatment.
- Trauma-informed care/treatment.
- SBIRT - Screening, Brief Intervention and Referral to Treatment.
The 'moral model' holds that the root cause of problematic AOD use is an individual's inherent moral weakness and lack of will power. This view has also been applied to particular communities and even races of people. There is no evidence for the perspective.
Which group of drugs is least likely to lead to addiction? ›Schedule V drugs have the fewest regulations and lowest penalties of any federal drug classification. Schedule V drugs have a legitimate accepted medical purpose, have a lower potential for abuse than Schedule IV drugs, and have a lower potential for addiction than Schedule IV drugs. Examples include: Lomotil.
What is the most widely used treatment modality for addiction treatment? ›Most substance use disorder treatment programs use a combination of group, individual, or family/couples counseling. According to the National Institute on Drug Abuse, group therapy is the most widely used treatment modality in addiction treatment programs.
What is the best evidence based practice for addiction? ›The most frequently used evidence-based behavioral therapies that currently have the most rigorous empirical support for treatment across a variety of substance use disorders include: Cognitive behavioral therapy (CBT).
What makes a treatment evidence-based? ›Evidence-based treatment (EBT) refers to treatment that is backed by scientific evidence. That is, studies have been conducted and extensive research has been documented on a particular treatment, and it has proven to be successful.
What are the 3 theories of addiction? ›- Theories of Addiction.
- Basic Six.
- • Biological/disease Model. • Psychodynamic Model. • Moral/spiritual Model. • Environmental Model. ...
- Biological.
- • Indicates a biological predisposition – neurotransmitter imbalance – brain.
- dysfunction.
- • Has been linked to the development of: • Addiction. • Mood disorders. ...
- Biological research.
What are the 3 models of addiction? ›
Well-supported evidence suggests that the addiction process involves a three-stage cycle: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation.
What is the three factor model of addiction? ›Three-factor model. Accepted research now shows that some people have vulnerabilities to addiction and has established a three-factor standard for vulnerability to drug addiction: genetic factors, environmental factors, and repeated exposure to drugs of use.
What is the most prominent substance use disorder? ›Alcohol use disorder is still the most common form of substance use disorder in America, fueled by widespread legal access and social approval of moderate drinking.
What is the best solution to prevent drug addiction? ›- avoiding places where you know drugs and alcohol will be available.
- surrounding yourself with friends who don't use drugs.
- knowing how to resist temptation.
- learning how to cope with stress and relax without drugs.
- distracting yourself with activities like exercise or listening to music.
- Don't hold an intervention on the spur of the moment. ...
- Plan the time of the intervention. ...
- Do your homework. ...
- Appoint a single person to act as a liaison. ...
- Share information. ...
- Stage a rehearsal intervention. ...
- Anticipate your loved one's objections. ...
- Avoid confrontation.
I was recently struck by this quote from “The Black Swan” author Nassim Taleb: “The three most harmful addictions are heroin, carbohydrates and a monthly salary.”
What drug is known as the assassin of the youth? ›Mephedrone, assassin of youth.
What drugs have the lowest potential for abuse? ›Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence. Examples of Schedule IV drugs are: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol.
Who is involved in addiction treatment? ›As part of a drug treatment program, behavior therapy — a form of psychotherapy — can be done by a psychologist or psychiatrist, or you may receive counseling from a licensed alcohol and drug counselor. Therapy and counseling may be done with an individual, a family or a group.
What is the most common form of medical treatment for opioid addiction? ›The most common medications used in the treatment of opioid addiction are methadone, buprenorphine and naltrexone. Counseling is recommended with the use of each of these medications.
Which therapy is often used for those suffering from an addiction? ›
CBT also gives patients tools to cope with stressful situations without turning to negative thinking and behavior patterns, and it is especially helpful for treating drug abuse and addiction.
What are the 4 C's of addiction? ›These four factors, compulsion, craving, consequences and control, are unique to addiction alone and are classified as the 4 C's. The behaviors of most addicts are very similar.
What are the top 3 priority assessment findings that support addiction? ›What are the top 3 priority assessment findings that support addiction? Based on the assessment findings, it is clear that substance abuse is an issue, and the top three priority assessments are impaired social functioning, the risk for self-harm, and alteration in thought processes.
What are the 4 P's of addiction? ›The 4Ps stand for Parents, Partner, Past, and Present To conduct the 4Ps Screening: ASK: Parents: Did any of your parents have problems with alcohol or other drug use? Partner: Does your partner have a problem with alcohol or drug use?
What are the three criteria for evidence-based treatment? ›- Best Available Evidence. ...
- Clinician's Knowledge and Skills. ...
- Patient's Wants and Needs.
Disadvantages of evidence-based practice include the shortage of evidence, the oversight of common sense, and the length of time and difficulty of finding valid credible evidence. Basing practice on evidence requires there to be some kind of evidence on your disease, issue, or question.
What is the greatest benefit of evidence based therapy and why? ›The ultimate goal of EBT is to promote safe, healthy, consistent, cost-effective psychotherapies that are then associated with greater effectiveness and accountability. Some practitioners rely less on evidence-based data, which drastically compromises the quality of care provided to clients.
Is it evidence-based or evidence-based? ›A widely used adjective in education, evidence-based refers to any concept or strategy that is derived from or informed by objective evidence—most commonly, educational research or metrics of school, teacher, and student performance.
What are evidence-based treatment interventions? ›What are Evidence Based Interventions (EBI)? Evidence-based interventions (EBI) are treatments that have been proven effective (to some degree) through outcome evaluations. As such, EBI are treatments that are likely to be effective in changing target behavior if implemented with integrity.
What's evidence-based intervention? ›Evidence-based interventions are practices or programs that have evidence to show that they are effective at producing results and improving outcomes when implemented. The kind of evidence described in ESSA has generally been produced through formal studies and research.
What are the two major theories of addiction? ›
The first concen- trates on the neurobiological effects of drugs, and explains drug dependence in biological terms. The second approach is psycho- logical, with explanations concentrating on behavioural models and individual differences.
What are the 5 components of addiction? ›Authors Sussman and Sussman (2011) conduct a literature search to determine the definition of addiction, landing on and further defining five common elements: (1) feeling different; (2) preoccupation with the behavior; (3) temporary satiation; (4) loss of control; and, (5) negative consequences.
What are the 6 components of addiction? ›Griffiths (2005) has operationally defined addictive behavior as any behavior that features what he believes are the six core components of addiction (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse).
Which part of the brain is responsible for addiction? ›The part of the brain that causes addiction is called the mesolimbic dopamine pathway. It is sometimes called the reward circuit of the brain.
What is the most popular model for the treatment of substance abuse? ›Behavioral therapy is perhaps the most commonly utilized types of treatment for addiction that is frequently used during substance rehabilitation. A general behavioral therapeutic approach has been adapted into a variety of effective techniques.
How long does it take for dopamine receptors to reset? ›Research has found that it is not easy to adjust dopamine levels after extensive use of dopamine-heavy drugs. So how long for dopamine receptors to heal? On average, it may take approximately 14-months to achieve normal levels in the brain with proper treatment and rehabilitation.
What is the wheel of change in addiction? ›There are four main stages in this model: precontemplation, contemplation, preparation, and action. Maintenance and relapse are also sometimes included as additional stages. These stages can be represented as a cycle, and in theory, people should go through these stages in sequence.
What are the six stages of change in addiction? ›The TTM posits that individuals move through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination.
What are the 5 stages of change in recovery? ›What Are the Five Stages of Change? The five stages of addiction recovery are precontemplation, contemplation, preparation, action and maintenance. Read on to find out more about the various stages.
What is one drug therapy difference between African Americans and Caucasians? ›ACE inhibitors seem to be less effective in the treatment of black patients with heart failure compared with white patients. This may be due to low pre-existing activity of the renin-angiotensin system in blacks.
What is the heart drug for African Americans? ›
BiDil is approved for use with other heart medicines to treat heart failure in black patients to improve survival, improve heart failure symptoms, and help patients stay out of the hospital longer. There is little experience in patients with heart failure who experience significant symptoms while at rest.
Which drugs became widely prescribed in the 1960s as a safer and less addictive alternative to barbiturates? ›Because these are two of the most common health issues in the United States, benzodiazepines are widely prescribed and used. They were first introduced in the 1960s as a safer alternative to barbiturates, which are a similar kind of drug with more dangerous side effects.
What are some African American barriers to treatment? ›Racism and Violence
A mistrust in authority is often seen because of the racism that follows. Black people are also more susceptible to death by suicide and violence that causes PTSD at a higher rate. The violence and rejection from other communities make it more difficult for the Black community to reach out for help.
Ethnic differences in drug metabolism may result from differences in distribution of a polymorphic trait and mutations which code for enzymes with abnormal activity which occur with altered frequency in different ethnic groups.
What treatment was given to the blacks? ›The Blacks were segregated in public spaces like schools hospitals, theatres, churches and transport system. They were not treated as equals with the White Europeans. THe Blacks fought against this discrimination under the leadership of Nelson Mandela and the African National Congress.
Why can't African Americans take ACE inhibitors? ›Black people are labelled “low-renin responders” so are less likely to respond to ACE inhibitors.
What drug has the most significant effect on the heart? ›Cocaine is probably the drug best known for deleterious effects on the heart. As the body metabolizes Cocaine, an array of ensuing effects may result in one or more serious medical emergencies.
Can African Americans take lisinopril? ›However, lisinopril was associated with an increased risk for heart failure (relative risk [RR] for African Americans=1.32; 95% CI, 1.11–1.58) and stroke (RR for African Americans=1.4; 95% CI, 1.17–1.68), and amlodipine was associated with a higher risk of heart failure (RR in African Americans=1.47; 95% CI, 1.24–1.74) ...
What is the most abused drug in the elderly? ›Alcohol is the most used drug among older adults, with about 65% of people 65 and older reporting high-risk drinking, defined as exceeding daily guidelines at least weekly in the past year.
What are the oldest drugs used? ›Abstract. Opium has been known for millennia to relieve pain and its use for surgical analgesia has been recorded for several centuries. The Sumerian clay tablet (about 2100 BC) is considered to be the world's oldest recorded list of medical prescriptions.
What drug was banned in the 1920s? ›
In 1920, the Dangerous Drugs Act limited the production, import, export, possession, sale or distribution of cocaine to licensed persons.
What is the first line for opioid use disorder? ›First-line treatment for patients with OUD most commonly consists of pharmacotherapy with an opioid agonist or antagonist and adjunct psychosocial treatment. However, due to patient preference or availability, it may be necessary to treat individuals with either medication or psychosocial treatment alone.
What are 3 medications that can be used to treat opioid use disorder? ›Effective medications exist to treat opioid use disorder: methadone, buprenorphine, and naltrexone. These medications could help many people recover from opioid use disorder, but they remain highly underutilized.
What is the new drug for addiction? ›The FDA recently approved buprenorphine for the treatment of opiate addiction. Psychologists helped develop the drug and will provide key services to patients treated with it.