Health Disparities Persist in Patient Access to Opioid Treatments

Women, as well as Black and Hispanic populations, have faced longstanding health disparities in patient access to opioid treatments like buprenorphine, a Mayo Clinic study published in JAMA Network Open found.

Buprenorphine, approved by the FDA in 2002, is one of the key medications used in medication-assisted treatment (MAT) for opioid use disorder (OUD). Since its approval, an abundance of evidence has shown the impact buprenorphine has in reducing opioid overdose.

Researchers examined trends in access to buprenorphine and disparities in access after an opioid-related emergency department visit between 2014 and 2020.

The study of over 72,000 emergency department visits found that fills were generally lower for female individuals, adults over 41 years old, Black patients, and Hispanic patients.

However, access to buprenorphine did increase over time for all populations.

The findings were not shocking considering that racial and ethnic populations often face obstacles during care due to systemic racism, provider mistrust, cumbersome reimbursement practices, and social determinants of health, the researchers stated.

“The persistence of the disparities is frustrating,” Molly Jeffery, PhD, scientific director for the Division of Emergency Medicine Research at Mayo Clinic and the study's senior author, said in the press release. “This is a truly lifesaving treatment. But it does appear that all groups are gaining access over time, which is what we want to see.”

“Making it easy to access safe and effective treatment is the best way to fight the epidemic of opioid overdoses, which has gotten worse during the COVID-19 pandemic,” Jeffery continued.

During the pandemic in 2020, opioid-involved overdose mortality rates reached a record high of 69,710.

Getting more physicians to prescribe buprenorphine is key to closing the existing health disparities, the press release stated.

“We know exactly what to do to close the gap, get more healthcare providers, particularly primary care providers, involved in prescribing buprenorphine," Jeffery said. "Mayo Clinic recognizes the importance of primary care access to buprenorphine, and our clinicians are addressing the disparity gap by prescribing buprenorphine whenever appropriate and providing it through a primary care program and an addiction clinic."

A separate study found that just under 56,000 medical providers are eligible to prescribe buprenorphine. Yet, even when providers are qualified to prescribe buprenorphine, they face limits in how many patients they treat with MAT.

In addition, researchers found that qualified providers were not taking on the maximum allowed patient panels.

“To combat the overdose crisis, people with OUD need better access to evidence-based treatments, which in too many places remain scarce,” the researchers stated. “In addition, federal regulations permit clinicians to prescribe it in community-based settings, such as primary care offices.” 

The Mainstreaming Addiction Treatment Act (MAT Act) would get rid of the licensing and training required to prescribe buprenorphine, as well as get rid of patient panel size restrictions.