Race in Addiction Treatment: Addressing the Accessibility Gap

Buprenorphine disparities highlight impact of race in addiction treatment.

A recent study from the University of Michigan shows that white, non-Hispanic patients are getting treated for opioid dependency through prescribed buprenorphine at rates exponentially higher than the black community. The data is the latest reminder of the glaring reality of race-based access disparities in addiction treatment. Researchers found that white populations are almost 35 times as likely to have a buprenorphine-related medical visit than black Americans. While the enduring clinical consensus is that buprenorphine and other medication-assisted treatment (MAT) resources are the gold standard for opioid dependency treatment, there remains a wide and noticeable gap that directly translates to higher rates of mortality and continued addiction. Recent data suggests that, from 2016-2017, the mortality rate among Black, non-Hispanic individuals rose by 25 percent, compared to the 11 percent increase among white, non-Hispanic individuals.

Accessing Buprenorphine In Addiction Treatment

While regulations on buprenorphine have relaxed in recent years, accessing the drug can still be difficult. In order to write a prescription for the drug, physicians must complete mandatory training, apply for a physician waiver, complete a buprenorphine specialized training, send the appropriate documentation to the DEA, obtain a special identification number, and undergo a 45-day review. The DEA also demands that use be monitored by physicians through follow-up visits and record keeping. Only five percent of physicians have taken the special training to prescribe it, and those that can have a cap on the number of patients they can treat. Even though buprenorphine lasts longer than other drugs, visits to the physician may be more numerous, which means more costly.

The Economics of Race in Addiction Treatment

One of the common reasons why buprenorphine has higher attainability among whites is due to the financial restriction. “Most of the white patients either paid cash (40 percent) or relied on private insurance (35 percent) to fund their buprenorphine treatment” according to study author and University of Michigan professor, Pooja Lagisetty. These visits can be very costly to lower-income individuals. Common brands of FDA-approved buprenorphine include Suboxone, Zubsolv and Bunavail. These drugs are mixed with naloxone, a medication designed to treat a narcotic overdose.

What Can Be Done to Universalize Access?

With the increase of opiate use in the black community, it is imperative that the impact on race in addiction treatment is further explored.  The racial gap in buprenorphine administration comes at a surprise to the director of the National Institute on Drug Abuse, Dr. Nora Volkow, “Surprising because the disparity is so large.” The institute prioritizes the education of buprenorphine to doctors, yet it is still not as widely used by most physicians. Many have called for the review of the oversight process and further laxing of regulations to make the drug more accessible across the board.

Most advocates for buprenorphine are demanding insurance cover more of the cost in hopes of increasing affordability. Volkow noticed that more Americans with an opioid use disorder have access to buprenorphine, but lawmakers need to understand why it is not benefiting all patients that need it.

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