Opioid mortality rates remain at record highs in the United States. Buprenorphine is an effective, first-line treatment for opioid use disorder. This study tested whether, despite a substantial increase in access to this life-saving medication overall, racial/ethnic minorities may not have equal access.
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While methadone is an effective, low cost medication for opioid use disorder that’s easily accessible in the United States through community clinics, a newer medication for opioid use disorder, buprenorphine, is more effective for some people. Buprenorphine also allows for more freedom and flexibility given that this medication is picked up at the pharmacy and taken home, while methadone patients must get this medication from opioid treatment programs and, at least initially, attend the programs daily. Buprenorphine, however, is relatively expensive, and can only be prescribed by physicians or nurse practitioners with a special license. It is thought that wealthier, White individuals with more financial and healthcare resources (e.g., health insurance) have better access to this buprenorphine, while racial/ethnic minorities who tend to be less wealthy, on average, may have difficulty accessing this medication. This study explored this hypothesis.
The research team combined data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey outpatient department component from 2004 to 2015. The surveys, which provide nationally–representative estimates of outpatient care provided in the United States by non–federally–employed physicians, capture physician-reported medications prescribed during each office visit as well as demographic characteristics and expected source of payment. Notably, results reflect buprenorphine prescriptions for all individuals, not necessarily just people with opioid use disorder. The sample was approximately 88% White, 8% Black, 4% Other, and 51% female.
From 2004 to 2015, the number of prescriber visits for buprenorphine rose from 0.04% to 0.36% of all outpatient prescriber visits, representing 13.4 million visits between 2012 and 2015. After accounting for payment method, sex, and age, the study’s authors found that White patients were 0.77 times more likely to receive buprenorphine at their prescriber visits than their Black counterparts.
Results also show that across all time periods assessed, self-pay patients – in other words, those with more financial resources – were 12.3 times more likely to be prescribed buprenorphine compared to those with private insurance. There was also a marked increase in the number of individuals receiving buprenorphine via self-pay from 2008-2015.
Figure 1. Odds ratios depicting likelihood of buprenorphine prescriptions, where White individuals act as the comparison group, demonstrating that individuals identifying as Black and Other are significantly less likely to be prescribed buprenorphine than those identifying as White.
Figure 2. Odds ratios depicting likelihood of a buprenorphine prescription being given based on an individual’s payment method for their medical treatment, where private pay acts as the comparison group, indicating that self-pay patients are significantly more likely to receive a buprenorphine prescription as compared to all other payment methods.
The authors’ findings confirm what has long been suspected by addiction treatment experts, that White individuals and those with greater financial/healthcare resources are more likely to receive buprenorphine to manage opioid use disorder, versus racial/ethnic minorities and those with less financial/healthcare resources. This is in spite of the fact that opioid use disorder occurs at similar rates across racial groups and socioeconomic classes. Further, given this study was agnostic to whether individuals had opioid use disorder, there is no compelling reason why prescription rates should be different by race. This finding is consistent with previous work by Stein and colleagues and Hansen and colleagues, showing racial inequities in access to buprenorphine. Findings also highlight a possible trend in providers licensed to prescribe buprenorphine taking cash only, meaning buprenorphine may be becoming even less accessible to those without financial means.
Lagisetty, P. A., Ross, R., Bohnert, A., Clay, M., & Maust, D. T. (2019). Buprenorphine treatment divide by race/ethnicity and payment. JAMA Psychiatry, (ePub ahead of print). doi: 10.1001/jamapsychiatry.2019.0876
l
While methadone is an effective, low cost medication for opioid use disorder that’s easily accessible in the United States through community clinics, a newer medication for opioid use disorder, buprenorphine, is more effective for some people. Buprenorphine also allows for more freedom and flexibility given that this medication is picked up at the pharmacy and taken home, while methadone patients must get this medication from opioid treatment programs and, at least initially, attend the programs daily. Buprenorphine, however, is relatively expensive, and can only be prescribed by physicians or nurse practitioners with a special license. It is thought that wealthier, White individuals with more financial and healthcare resources (e.g., health insurance) have better access to this buprenorphine, while racial/ethnic minorities who tend to be less wealthy, on average, may have difficulty accessing this medication. This study explored this hypothesis.
The research team combined data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey outpatient department component from 2004 to 2015. The surveys, which provide nationally–representative estimates of outpatient care provided in the United States by non–federally–employed physicians, capture physician-reported medications prescribed during each office visit as well as demographic characteristics and expected source of payment. Notably, results reflect buprenorphine prescriptions for all individuals, not necessarily just people with opioid use disorder. The sample was approximately 88% White, 8% Black, 4% Other, and 51% female.
From 2004 to 2015, the number of prescriber visits for buprenorphine rose from 0.04% to 0.36% of all outpatient prescriber visits, representing 13.4 million visits between 2012 and 2015. After accounting for payment method, sex, and age, the study’s authors found that White patients were 0.77 times more likely to receive buprenorphine at their prescriber visits than their Black counterparts.
Results also show that across all time periods assessed, self-pay patients – in other words, those with more financial resources – were 12.3 times more likely to be prescribed buprenorphine compared to those with private insurance. There was also a marked increase in the number of individuals receiving buprenorphine via self-pay from 2008-2015.
Figure 1. Odds ratios depicting likelihood of buprenorphine prescriptions, where White individuals act as the comparison group, demonstrating that individuals identifying as Black and Other are significantly less likely to be prescribed buprenorphine than those identifying as White.
Figure 2. Odds ratios depicting likelihood of a buprenorphine prescription being given based on an individual’s payment method for their medical treatment, where private pay acts as the comparison group, indicating that self-pay patients are significantly more likely to receive a buprenorphine prescription as compared to all other payment methods.
The authors’ findings confirm what has long been suspected by addiction treatment experts, that White individuals and those with greater financial/healthcare resources are more likely to receive buprenorphine to manage opioid use disorder, versus racial/ethnic minorities and those with less financial/healthcare resources. This is in spite of the fact that opioid use disorder occurs at similar rates across racial groups and socioeconomic classes. Further, given this study was agnostic to whether individuals had opioid use disorder, there is no compelling reason why prescription rates should be different by race. This finding is consistent with previous work by Stein and colleagues and Hansen and colleagues, showing racial inequities in access to buprenorphine. Findings also highlight a possible trend in providers licensed to prescribe buprenorphine taking cash only, meaning buprenorphine may be becoming even less accessible to those without financial means.
Lagisetty, P. A., Ross, R., Bohnert, A., Clay, M., & Maust, D. T. (2019). Buprenorphine treatment divide by race/ethnicity and payment. JAMA Psychiatry, (ePub ahead of print). doi: 10.1001/jamapsychiatry.2019.0876
l
While methadone is an effective, low cost medication for opioid use disorder that’s easily accessible in the United States through community clinics, a newer medication for opioid use disorder, buprenorphine, is more effective for some people. Buprenorphine also allows for more freedom and flexibility given that this medication is picked up at the pharmacy and taken home, while methadone patients must get this medication from opioid treatment programs and, at least initially, attend the programs daily. Buprenorphine, however, is relatively expensive, and can only be prescribed by physicians or nurse practitioners with a special license. It is thought that wealthier, White individuals with more financial and healthcare resources (e.g., health insurance) have better access to this buprenorphine, while racial/ethnic minorities who tend to be less wealthy, on average, may have difficulty accessing this medication. This study explored this hypothesis.
The research team combined data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey outpatient department component from 2004 to 2015. The surveys, which provide nationally–representative estimates of outpatient care provided in the United States by non–federally–employed physicians, capture physician-reported medications prescribed during each office visit as well as demographic characteristics and expected source of payment. Notably, results reflect buprenorphine prescriptions for all individuals, not necessarily just people with opioid use disorder. The sample was approximately 88% White, 8% Black, 4% Other, and 51% female.
From 2004 to 2015, the number of prescriber visits for buprenorphine rose from 0.04% to 0.36% of all outpatient prescriber visits, representing 13.4 million visits between 2012 and 2015. After accounting for payment method, sex, and age, the study’s authors found that White patients were 0.77 times more likely to receive buprenorphine at their prescriber visits than their Black counterparts.
Results also show that across all time periods assessed, self-pay patients – in other words, those with more financial resources – were 12.3 times more likely to be prescribed buprenorphine compared to those with private insurance. There was also a marked increase in the number of individuals receiving buprenorphine via self-pay from 2008-2015.
Figure 1. Odds ratios depicting likelihood of buprenorphine prescriptions, where White individuals act as the comparison group, demonstrating that individuals identifying as Black and Other are significantly less likely to be prescribed buprenorphine than those identifying as White.
Figure 2. Odds ratios depicting likelihood of a buprenorphine prescription being given based on an individual’s payment method for their medical treatment, where private pay acts as the comparison group, indicating that self-pay patients are significantly more likely to receive a buprenorphine prescription as compared to all other payment methods.
The authors’ findings confirm what has long been suspected by addiction treatment experts, that White individuals and those with greater financial/healthcare resources are more likely to receive buprenorphine to manage opioid use disorder, versus racial/ethnic minorities and those with less financial/healthcare resources. This is in spite of the fact that opioid use disorder occurs at similar rates across racial groups and socioeconomic classes. Further, given this study was agnostic to whether individuals had opioid use disorder, there is no compelling reason why prescription rates should be different by race. This finding is consistent with previous work by Stein and colleagues and Hansen and colleagues, showing racial inequities in access to buprenorphine. Findings also highlight a possible trend in providers licensed to prescribe buprenorphine taking cash only, meaning buprenorphine may be becoming even less accessible to those without financial means.
Lagisetty, P. A., Ross, R., Bohnert, A., Clay, M., & Maust, D. T. (2019). Buprenorphine treatment divide by race/ethnicity and payment. JAMA Psychiatry, (ePub ahead of print). doi: 10.1001/jamapsychiatry.2019.0876
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