Black individuals, older persons less likely to receive opioid cessation drug

In Wisconsin, Black individuals make up the majority of opioid related deaths, yet they are least likely to have access to the prescription treatment buprenorphine.

Nation, state and countywide, overdose deaths are on the rise, many of the fatalities attributed to fentanyl and other opioids. In Wisconsin, the rate of opioid overdose deaths rose from 15.8 per 100,000 in 2019 to 21.1 per 100,000 in 2020. La Crosse County had an even sharper increase, with a 2019 rate of 14.3 and a 2020 rate of 25.3.

In 2020, Milwaukee County, which has the largest population of Black or African American residents in the state, reached a rate of 44.6 per 100,000. Statewide, 2020 opioid deaths totaled 1,227.

In an effort to help wean individuals off highly addictive opioids, and reduce risk of serious health consequences or death, the FDA allows prescribing of buprenorphine, an opioid partial agonist that gives sensations of euphoria to a lesser extent than full opioid agonists like methadone. A 2014 study found patients who received the drug were 1.8 times more likely to stick with a treatment plan than those who took the placebo. 

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A newly published study from Mayo Clinic found while prescriptions of buprenorphine have increased in recent years, the rate change was significantly lower for Black patients, who, from 2014 to 2020, had a prescription percent change of 44%, compared to 60.5% for white patients.

The study looked at 3,110 filled prescriptions of buprenorphine from 72,055 emergency department visits nationwide from 2014 to 2020. Hispanic persons, those over age 41, and women also had a lesser access rate increase than white males, a trend that persisted over the years. Those with higher socioeconomic status had an advantage in securing the drug.

Molly Jeffery

Molly Jeffery

The disparity is “frustrating,” says Molly Jeffery, scientific director for Mayo Clinic’s Division of Emergency Medicine Research and the study’s senior author. However, she says it is “not surprising” that the potentially life saving treatment is less accessible to certain groups or demographics.

Obstacles to receiving the drug, the study authors say, include systemic racism, mistrust of health care professionals and the health care system, not enough clinicians able and prepared to prescribe buprenorphine in the emergency department, regulatory requirements, reimbursement issues, and addiction and mental health stigmas.

“The laws that currently limit access to buprenorphine are a legacy of an earlier opioid epidemic from literally 100 years ago. Those laws are based in mistrust of physicians and patients and a fundamental misunderstanding about substance use disorders,” says Jeffery. “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.”

Increasing access for “vulnerable” individuals requires getting more health care providers involved in prescribing buprenorphine, Jeffery says. In addition, policy barriers need to be removed, she says. These include the extra requirements for clinicians in prescribing the drug, though those stipulations have become less stringent. In 2021, the qualifications were relaxed to exempt providers from requirements under the Controlled Substances Act that call for eight hours of training. There is also no longer a stipulation to connect patients with counseling.

However, providers are currently limited to prescribing buprenorphine to no more than 30 patients at a time, and are required to notify the Substance Abuse and Mental Health Services Administration (SAMHSA) when they plan to write a prescription. 

Further regulation adjustments will be needed to connect the growing number of patients with the drug, Jeffery believes, as stipulations currently in place “needlessly limit access to a safe and effective treatment and increase stigma.”

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