Diminishing access to buprenorphine significantly affects minorities with OUD
Recent research has assessed racial and ethnic disparities in prescriptions filled with buprenorphine and extended-release naltrexone during the COVID-19 pandemic. Investigators sought to determine whether disruptions to these prescriptions filled for opioid use disorder (OUD) during the pandemic differed by race, ethnicity or insurance status and type of payer. .
Since the administration of these treatments has been discontinued during the pandemic, members of racial and ethnic minority groups have experienced increased risks, not only with the COVID-19 virus, but also with surrounding opioid overdose, for compared to white people. It was not yet known whether or not prescriptions filled for the drugs varied by racial and ethnic group.
Investigators, led by Thuy Nguyen, PhD, Department of Health Management and Policy, School of Public Health, University of Michigan, ultimately found that these disparities could have been worsened during the pandemic. Patients from racial and ethnic minority groups experienced more disruption when filling prescriptions for any of the treatments to alleviate OUD, compared to white patients.
Investigate delivery disruptions
Retail pharmacy claims from May 2019 to June 2021 were assessed for the cross-sectional study. The Symphony Health database includes 92% of retail claims in the United States and contains race, ethnicity data across all insurance statuses and payer categories. Individual information was included if prescriptions for buprenorphine and extended-release naltrexone were filled.
Investigators identified interrupted time series to estimate levels and trends of buprenorphine and naltrexone prescriptions dispensed before and after the onset of the pandemic. Data was analyzed from July 2021 to March 2022.
Weekly rates of prescriptions dispensed per 1000 patients and the proportion of supply 14 days or longer were calculated for the primary study outcome. Analyzes were stratified by race and ethnicity of patients. For white and black patients, they were then stratified by insurance status and payer type.
A total of 1,556,860 people filled prescriptions for buprenorphine and 127,506 people filled prescriptions for extended-release naltrexone on time. Caucasians accounted for the vast majority in filling buprenorphine prescriptions (42.7%) as well as naltrexone prescriptions (41.6%). Blacks made up the second largest proportion at 6.1% and 6.4%, respectively.
While pre-pandemic increases in buprenorphine refill rate leveled off for all groups after onset, investigators wrote that extended-release naltrexone had a consistent level (from 10.0% for white patients with private insurance ; P P P = 0.001 to 52.0 percentage points for black patients with private insurance; P
Medicare and cash-paying patients had a reduced buprenorphine refill rate, but with greater decreases for black patients (Medicare: 10.0%; P P P = 0.004; cash: 15.0%; P
Investigators observed that early in the pandemic, there were significant decreases in buprenorphine refills for members of minority groups, but not for white patients. Black patients experienced a level decrease of 2.5% and Hispanic patients a level decrease of 4%.
“This study found that the COVID-19 pandemic was associated with immediate decreases in prescriptions filled with buprenorphine by members of racial and ethnic minority groups, but not by white individuals,” the investigators concluded. “These findings suggest that members of racial and ethnic minority groups experienced greater losses of access to buprenorphine during the pandemic, regardless of payer type.”
The study, “Racial and Ethnic Disparities in Prescriptions Filled with Extended-Release Buprenorphine and Naltrexone During the COVID-19 Pandemic,” was published in Jama Network.