Racial and Economic Disparities in Buprenorphine Prescriptions

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Buprenorphine treatment may be more available to individuals who are white, use self-pay, or have private insurance.

Buprenorphine treatment may be more available to individuals who are white, use self-pay, or have private insurance, according to a research letter published in JAMA Psychiatry. This disparity in treatment based on income and race/ethnicity highlights the need for additional research and policy measures.

This study examined data from the National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey, which provide information on medications prescribed by physicians, associated demographic, and payment source variables. Visits resulting in buprenorphine prescriptions were included, with the sample divided into 4-year periods. Buprenorphine prescription rates were estimated by payment and race/ethnicity, with the 2012 to 2015 period chosen to assess the relationship between race/ethnicity and buprenorphine prescription rates. This association was evaluated using logistic regression after adjusting for sex, age, and payment type.

Buprenorphine visits accounted for 0.04% of all ambulatory visits in 2004 and rose to 0.36% in 2015, accounting for a total of 13.4 million visits between 2012 and 2015. Whites received more buprenorphine prescriptions (12.7 million; 95% CI, 8.6-16.8 million) than other races/ethnicities (363,000; 95% CI, 134,000-594,000). Across all years, self-pay and private insurance remained the most common methods of payment for buprenorphine treatment. However, buprenorphine visits increased among patients using self-pay, from 585,568 between 2004 and 2007 (95% CI, 0-1.3 million) to 5.3 million between 2012 and 2015 (95% CI, 2.5-8.5 million), corresponding to  39.6% of visits. Blacks had dramatically lower odds (adjusted odds ratio, 0.23; 95% CI, 0.13-0.44) of being prescribed buprenorphine after adjusting for sex, age, and payment type.

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“[B]uprenorphine treatment is concentrated among white persons and those with private insurance or use self-pay. This finding in nationally representative data builds on a previous study that reported buprenorphine treatment disparities on the basis of race/ethnicity and income in New York City,” concluded the study authors. “With rising rates of opioid overdoses, it is imperative that policy and research efforts specifically address racial/ethnic and economic differences in treatment access and engagement.”

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Lagisetty PA, Ross R, Bohnert A, et al. Buprenorphine treatment divide by race/ethnicity and payment [published online May 8, 2019]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2019.0876