Racial, ethnic disparities persist, increase in buprenorphine treatment

Racial and ethnic disparities in buprenorphine treatment duration increased from 2006 to 2020, but particularly more in recent years, researchers wrote in a research letter in JAMA Psychiatry.

Buprenorphine is used to treat opioid use disorders and reduce overdose risk. “Duration of buprenorphine treatment is a measure of quality of care,” Huiru Dong, PhD, a postdoctoral research fellow at Massachusetts General Hospital, and colleagues wrote.

According to the authors, patients from underrepresented populations are more likely to discontinue buprenorphine treatment earlier than white patients. However, no nationally representative studies have assessed buprenorphine treatment duration over time across racial and ethnic groups.

Dong and colleagues conducted a cohort study that analyzed a random sample of buprenorphine prescriptions in IQVIA Longitudinal Prescription Data that included race and ethnicity data and were filled from 2006 through 2020.

The researchers wrote that start of a new treatment episode was defined as the date a prescription was filled after more than 14 days without a buprenorphine supply. The percentage of buprenorphine episodes lasting at least 180 days was also examined.

Both outcome measures were compared across racial and ethnic groups using analysis of variance.

Among 11,250,354 buprenorphine prescriptions, 866,904 treatment episodes were contributed by 240,923 patients (mean age, 37 years; 57% male). Of those, 8.1% were Black, 6.3% Hispanic, 84.1% white and 1.5% other race and ethnicity. The median number of sequential prescriptions in a treatment episode was three, and the median prescription duration was 14 days.

According to the authors, treatment durations differed significantly across racial and ethnic groups, with white patients consistently having the longest durations. Treatment among white patients increased starting in 2017, but consistently decreased among Black patients in 2014, and in Hispanic patients from 2009.

Overall, 22.8% to 26.3% of treatment episodes were at least 180 days. Minority populations consistently had fewer buprenorphine episodes of at least 180 days compared with white patients. From 2011, the percentage of episodes of at least 180 days increased among all racial and ethnic groups. However, this trend reversed for Black patients beginning in 2016.

“The observed heterogeneity in buprenorphine treatment duration among racial and ethnic groups may reflect disproportionate structural barriers in treatment retention for [opioid use disorder],” Dong and colleagues wrote. “Racial and ethnic inequities in social determinants of health, such as access to education, employment and medical care, could affect substance use treatment initiation, engagement, and outcomes.”