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Buprenorphine Prescriptions Divided by Race and Income

Critical disparities identified among patient population groups

With Courtney Kominek, PharmD, BSPS, CPE, and Jeremy Adler, DMSc, PA-C

As concerns remain regarding opioid-related overdoses and deaths, major efforts continue to be made to curb the misuse of opioids. However, emerging research suggests that gross racial and financial disparities in access to treatment for opioid addiction, or opioid use disorder (OUD).1

Researchers at the University of Michigan and Veterans Administrations Ann Arbor Healthcare System recently published the results of an outpatient study on opioid addiction treatment,revealing that white patients are nearly 35 times more likely than black patients to receive a prescription for buprenorphine hydrochloride, a partial opioid agonist that is one of three available medications for treatment of OUD. Furthermore, the percentage of buprenorphine-related visits paid for by cash or private insurance exceeded the percentage paid for by Medicaid and Medicare.1

“We shouldn’t see differences this large, given that people of color have similar rates of opioid use disorder,” said lead author Pooja Lagisetty, MD, MSc, assistant professor in the Division of General Medicine at the University of Michigan, in a news release.2 “As the number of Americans with opioid use disorder grows, we need to increase access to treatment for black and low income populations, and be thoughtful about how we reach all those who could benefit from this treatment,” Dr. Lagisetty said.3

(Source: 123RF)

Findings

Dr. Lagisetty and her team reviewed information collected from two national surveys of physician-reported prescriptions: the National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Survey. These surveys document information from non-federally-affiliated outpatient clinics nationwide, including medications prescribed per office visit, patient demographics, and payment source.1

The researchers focused their analysis on data collected from visits during which buprenorphine was prescribed occurring between the years of 2004 and 2015. After aggregating the data from this time span into 4-year periods, the investigators conducted a logistic regression analysis on data from the most recent period, adjusting for age, sex, and payment method to test an association between race/ethnicity and acquisition of a buprenorphine prescription.1

The review revealed two key outcomes:

  • Buprenorphine was prescribed more often to white patients compared to those of other races (12.7 million [95% CI, 8.6 million-16.8 million] compared to 363,000 [95% CI, 134,000-594,000]).
  • The percentage of buprenorphine-related visits were paid:
    • 40% by cash
    • 34% by private insurance
    • 25% by Medicare or Medicaid.1

A Critical Analysis

Courtney Kominek, PharmD, BSPS, CPE, a clinical pharmacy specialist in pain management and a PPM Editorial Advisory Board member, weighed in on these findings. “I wish I could say I was surprised by the findings. Clearly, we as healthcare providers need to do better to make sure that all patients have equal opportunity for life-saving medication. It is important we offer buprenorphine to all patients with opioid use disorder.”

Dr. Kominek mentioned one aspect of disparity that could lead to more questions. “I wonder what the data would be like for patients actually filling their prescription. With so many patients paying out-of-pocket for physician visits, I anticipate the cost of the prescription being an additional barrier for patients taking the medication.”

Jeremy Adler, DMSc, PA-C, a California-based pain management specialist and CEO of Pacific Pain Medicine, acknowledged the potential for healthcare disparities as well. “I think that there are definitely issues in healthcare that we see discrimination in how they are approached. Pain is one of them; opioid use disorder as well.” He added that, “There has been a push to increase [the] management of opioid use disorder by a number of programs through Medicare and Medicaid, and I think that if there is still discrimination in that space, then we need to understand why. Is it a socioeconomic difference? Is it a racial/ethnic difference? Is it provider education? Is it population acceptance?”

In regard to the data analysis conducted by Dr. Lagisetty’s team, Dr. Adler recommended a need for more information. “The authors didn’t look at the data specific to opioid use disorder, but looked at it through the lens of buprenorphine prescriptions and coverage. Because buprenorphine has been marketed by a number of companies for pain which does not fall under the opioid use disorder population, I am not entirely sure what their results actually mean,” he explained to PPM.

Both he and Dr. Kominek agreed, however, that the stark difference in buprenorphine-related visits between groups was striking. “The numbers they were able to pull were much further apart than what I would have anticipated,” Dr. Adler said.

“I am quite surprised by the magnitude of difference based on race/ethnicity and that the number of black patients that were prescribed buprenorphine got worse in the second time period in light of the opioid overdose public health crisis,” Dr. Kominek said.

Last updated on: June 11, 2019
Continue Reading:
Buprenorphine: A Promising Yet Overlooked Tool
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