Access to medications for opioid use disorder linked to community racial/ethnic segregation
Community racial/ethnic composition appeared associated with residents’ access to specific medications for opioid use disorder, according to results of a cross-sectional study published in JAMA Network Open.
Researchers noted that regulation reforms are warranted to ensure these medications are equally accessible to all.
“The current gold standard for treating opioid use disorder involves use of one of three FDA-approved medications,” William C. Goedel, BA, of the department of epidemiology at Brown University School of Public Health, told Healio Psychiatry. “However, these medications are greatly underused. Although a larger body of research has tried to understand urban/rural differences in access to each of these medications, no studies to our knowledge had assessed potential differences in access by race and ethnicity, so we aimed to fill this gap.”
The current criterion standard for opioid use disorder treatment, as approved by the FDA, includes methadone, buprenorphine and naltrexone; however, the American Society for Addiction Medicine’s current treatment guidelines do not specify a preferred first-line medication for all patients with opioid use disorder, according to Goedel. Although little research exists that identifies which patients with opioid use disorder will respond better to which medications, a 2020 study found that treatment with either buprenorphine or methadone effectively reduced the risk for opioid overdose and opioid-related acute care utilization compared with certain nonpharmacological treatments. Further, researchers have hypothesized that access to these medications differs along racial lines, with one study reporting that at a ZIP code level in New York City, the percentage of residents who were African American in an area was negatively correlated with the proportion of residents who received buprenorphine and positively correlated with the proportion who received methadone.
Goedel and colleagues aimed to examine the degree to which capacity to provide buprenorphine and methadone varied with measures of racial/ethnic segregation. They included data from all 3,142 counties and county-equivalent divisions in the United States in 2016. They obtained racial/ethnic population distribution data from the American Community Survey and data on locations of facilities providing buprenorphine and methadone from Substance Abuse and Mental Health Services Administration databases. The researchers used two county-level measures of racial/ethnic segregation:
- dissimilarity, which represented the proportion of African American or Hispanic/Latino residents who would need to move census tracts to achieve a uniform spatial distribution of the population according to race/ethnicity; and
- interaction, which represented the probability that an African American or Hispanic/Latino resident will interact with a white resident and vice versa, assuming random mixing throughout census tracts.
As main outcomes and measures, Goedel and colleagues used county-level capacity to provide methadone or buprenorphine, which they defined as the number of facilities providing a medication per 100,000 population.
Results showed 18,868 facilities provided buprenorphine (5.9 facilities per 100,000 population) and 1,698 facilities provided methadone (0.6 facilities per 100,000 population). The researchers reported the following associations population makeup and total facilities providing methadone or buprenorphine:
- each 1% decrease in probability of interaction of a white resident with an African American resident was associated with 0.6 more facilities providing methadone per 100,000 population;
- each 1% decrease in probability of interaction of a white resident with a Hispanic/Latino resident was associated with 0.3 more facilities providing methadone per 100,000 population;
- each 1% decrease in probability of interaction of a white resident with an African American resident was associated with 8.17 more facilities providing buprenorphine per 100,000 population; and
- each 1% decrease in the probability of interaction of a white resident with a Hispanic/Latino resident was associated with 1.61 more facilities providing buprenorphine per 100,000 population.
“The social discourse in the 1960s and 1970s that led to the war on drugs framed heroin use as an urban problem primarily impacting communities of color,” Goedel said. “Methadone was first introduced as a medication to treat opioid use disorder at this time, so we hypothesized that communities of color would have disproportionately higher access to this medication over others. As the current wave of the opioid epidemic escalated in predominantly white rural and suburban areas in the early 2000s, buprenorphine was introduced as a medication with significantly fewer restrictions. Therefore, we similarly hypothesized that predominantly white communities would have better access to this medication. The current study supports these hypotheses and we hope that in the future, these findings can be used to advance equitable access to both of these medications across all communities.” – by Joe Gramigna
Disclosures: One study author reports grants from the NIH during the conduct of the study and outside the submitted work. The other authors report no relevant financial disclosures.