Colliding Crises: Racial Disparities in Opioid Use Disorder Treatment for Black Americans
Used by Permission of Copyright Holder
By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
https://www.qbhinc.com/our-team/
Staff Research and Content Writer
© Copyright – SUD RECOVERY CENTERS – A Division of Genesis Behavioral Services, Inc., Milwaukee, Wisconsin – November 2024– All rights reserved.
In a health care system grappling with an opioid crisis, racial and ethnic disparities persistently undermine the treatment of opioid use disorder for Black Americans.
There are staunch racial and ethnic disparities in access to and quality of treatment for opioid use disorder (OUD) in the United States, a situation exacerbated by the urgent opioid crisis. OUD affects over 2 million Americans each year, with approximately 80,000 overdose deaths in 2021 attributable to opioids. Black Americans face a disproportionately high risk of overdose deaths; since 2010, Black people in the United States have had a greater increase in opioid overdose-related mortality than other racial groups.
Methadone and buprenorphine, the standard treatments for OUD, are most effective at higher doses. Ensuring equitable access to these medications is crucial to address the opioid crisis and reduce overdose fatalities. However, Black patients are less likely to be prescribed medication to treat OUD and receive lower doses of medications compared to White patients, directly impacting their recovery trajectories.
A new study aimed to assess whether the racial disparities in OUD prescribing seen in usual care settings persist in clinical trials.
Why examine dosing disparities in clinical trials?
Examining treatment disparities in experimental settings is essential for understanding the generalizability of clinical trial evidence. If specific populations are subject to inadequate dosing in clinical trials, the applicability of the research findings to those groups is compromised. As a result, treatment recommendations for these groups may be incorrect and perpetuate inequities.
In this case, if Black patients are receiving inadequate doses of opioid use disorder (OUD) medications, the findings from these clinical trials will not lead to accurate recommendations for treating Black patients with OUD in real-world settings. Racial disparities in experiment design or findings, if not addressed, will perpetuate racial inequities in treatment and mortality for Black patients suffering from OUD.
What did this study find?
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Researchers identified racial disparities in dosing for methadone and buprenorphine across 1 and 3 clinical trials, respectively. These disparities align with those seen in usual care settings.
Black patients received lower doses of buprenorphine than White patients throughout the trials. The largest differences were in week 4, when Black patients were prescribed doses 2.5 mg lower than White patients. Similarly, Black patients received lower doses of methadone, with the dose difference increasing each week. The largest observed difference in methadone prescriptions was 16.7 mg between White and Black patients.
Why might Black patients be given lower doses of opioid treatment medications?
The researchers note that racial disparities in dosing identified in their analysis could be due to differences in trial enrolment (e.g., differential access to specific trials) or treatment decisions made during the trials.
The factors contributing to racial disparities in dosing for opioid use disorder (OUD) medications are likely due to a combination of structural, institutional, and interpersonal racism. For example, residential segregation due to structural racism may have impacted Black patients’ access to participate in specific trials. On an interpersonal level, unconscious or conscious racist beliefs among clinicians may have affected the doses that they gave Black patients.
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Of note, Black patients also had lower average opioid withdrawal scores at baseline. The researchers note that this could be again due to racial bias in how withdrawal was measured or recorded. It could also reflect Black patients’ mistrust of the medical system due to historically entrenched discrimination and ongoing racist practices, which may influence how they responded to baseline questioning. These withdrawal scores may have influenced the dosing of medication to Black patients, demonstrating the domino effect of ongoing racist beliefs and structures, however unconscious, in treatment outcomes for Black patients.
How can we address racial disparities in OUD treatment?
The researchers highlight several proposed recommendations to address racial disparities in dosing in clinical care settings, including:
- Campaigns to improve awareness of dosing recommendations among clinicians,
- Training for facility staff and managers on how to mitigate the impact of interpersonal racism on clinical decision-making,
- Oversight by accrediting bodies to assess treatment quality at treatment facilities, and
- Community-specific interventions that aim to address mistrust of the safety and effectiveness of OUD treatment.
Key Points
- Black Americans face higher rates of opioid-related overdose deaths compared to White Americans.
- Black patients are often prescribed lower doses of medications essential to treat opioid use disorder.
- This dosing disparity is seen in clinical practice and experimental trials, impacting treatment recommendations for Black patients.
- It is vital to address structural, institutional, and interpersonal racism to improve health outcomes for Black patients with opioid use disorder.
References
Ross, R. K., Inose, S., Shulman, M., Nunes, E. V., Zalla, L. C., Burlew, A. K., & Rudolph, K. E. (2024). Variation in opioid agonist dosing in clinical trials by race and ethnicity. JAMA Network Open, 7(10), e2436612. https://doi.org/10.1001/jamanetworkopen.2024.36612
Barnett, M. L., Meara, E., Lewinson, T., Hardy, B., Chyn, D., Onsando, M., Huskamp, H. A., Mehrotra, A., & Morden, N. E. (2023). Racial inequality in receipt of medications for opioid use disorder. New England Journal of Medicine, 388(19), 1779-1789. https://doi.org/10.1056/NEJMsa2212412