Black and Hispanic patients tend to receive less time in treatment than white patients.
Although studies have shown time and again that Black, Hispanic and indigenous people with opioid use disorder (OUD) are at a high risk of overdose fatalities, they continue to receive less time in treatment should they make the decision to get help before this happens. A new study from Harvard Medical School, which was published this month in JAMA Psychiatry, has concluded that opioid use disorder OUD treatment for white patients is longer than treatment for Black and Hispanic patients (these are the only minority populations included in the study).
The research team randomly surveyed a database searching for prescriptions for buprenorphine, which is a drug that treats narcotic dependence, in the fourteen-year span from 2006 to 2020. The sample population included 11 million prescriptions and 240,000 patients, who were “84.1% white, 8.1% Black, 6.3% Hispanic and 1.5% other races and ethnicities,” the team shared. In 2020, they found white patients received treatment for “a median of 53 days while Black and Hispanic patients received it for 44 and 35 days, respectively,”
“We wanted to break it down to granular data to really look at ‘what is each patient’s experience?’ That way we can help inform policies and improve access,” said study author Huiru Dong, a postdoctoral research associate at Harvard Medical School and Massachusetts General Hospital.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), buprenorphine (brand name Suboxone) is an opioid partial agonist which produces similar effects as opioids. However, these effects are much weaker. When taken as prescribed, it can effectively curtail OUD. SAMHSA suggests that the drug can “diminish the effects of physical dependency to opioids, such as withdrawal symptoms and cravings, increase safety in cases of overdose and lower the potential for misuse.”
Physicians and experts in the addiction field recommend those in OUD treatment take buprenorphine for at least 180 days. However, most do not make it that long before returning to opioid use.
“It is very concerning,” said Dr. Denis Antoine, director of the addiction treatment services clinic at Johns Hopkins Bayview Medical Center. “There’s a lot of literature showing that duration of treatment leads to better outcomes.”
While disparities still exist, the new study showed that treatment times improved for most Black and white patients since 2006. However, it worsened for Hispanic patients. By 2020, “duration increased from 47 days to 53 days for white patients and 35 to 44 days for Black patients, but decreased from 40 to 35 days for Hispanic patients,” the authors wrote.
“If it had been another random sample, it would probably look very similar to this one,” said Dr. Silvia Martins, professor of epidemiology and director of the Substance Use Epidemiology Unit at Columbia University Mailman School of Public Health, who was not involved with the study. “It shows that there are few Hispanic and Black patients receiving medication at all.”
National data from the Centers for Disease Control and Prevention (CDC) indicates, “From 2019 to 2020, overdose death rates increased 44% for Black people and 39% for American Indian and Alaska Native people.”
Given the national data and the results of the current study, Martins added, ““It builds on prior research that shows there are structural barriers for certain racial, ethnic and marginalized groups for methadone or buprenorphine treatment.”
It’s clear, if minority overdose deaths are going to decrease, they need to be at least given the same amount of time in treatment as their white counterparts and same level of access to Suboxone.