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Black Americans have experienced a sevenfold rise in opioid overdose deaths in the past decade — a larger increase than in any other racial or ethnic group. Nevertheless, disparities in treatment for opioid use disorder (OUD) remain poorly characterized. In this study, researchers analyzed claims data from a random sample of 23,000 Medicare beneficiaries enrolled on the basis of disability (mean age, 51) who experienced OUD-related events between 2016 and 2019. OUD-related events were defined as nonfatal overdose requiring an emergency department visit or hospitalization, hospitalization with infection related to intravenous drug use, or inpatient or residential stay for detoxification.
Compared with white enrollees, Black enrollees filled significantly fewer prescriptions for buprenorphine (13% vs. 23%) and naloxone (14% vs. 23%) in the 6 months following an OUD-related event. These differences persisted throughout the study period despite similar, frequent contact with healthcare providers among both Black and white enrollees in the 6 months following OUD-related events. Receipt of naltrexone was uncommon, and rates were similar in both groups (3%). Smaller disparities were noted for buprenorphine fills for Hispanic enrollees of any race compared with white enrollees: 19% vs 23%.
Barnett ML et al. Racial inequality in receipt of medications for opioid use disorder. N Engl J Med 2023 May 11; 388:1779. (https://doi.org/10.1056/NEJMsa2212412)
Comment
These results illustrate stark racial and ethnic disparities in OUD treatment despite similar insurance coverage and raise urgent questions about the effect of these disparities on OUD-related outcomes. Limitations of this study include the lack of data on methadone fills for OUD (which was not covered by Medicare during the study period) and a study population limited to Medicare enrollees who were disabled and mostly middle-aged.