Pandemic Linked to Racial, Ethnic Disparities in Buprenorphine Fill Rates

The COVID-19 pandemic was associated with a greater decrease in filled buprenorphine prescriptions for opioid use disorder (OUD) among individuals of racial and ethnic minority groups as compared to White individuals. Researchers published their findings in JAMA Network Open.

“COVID-19 disrupted delivery of buprenorphine and naltrexone treatment for [OUD], and during the pandemic, members of racial and ethnic minority groups experienced increased COVID-19 and opioid overdose risks compared with White individuals,” stated Thuy Nguyen, PhD, Department of Health Management and Policy, University of Michigan, and coauthors.

The cross-sectional study was conducted using claims from retail pharmacies between May 2019 and June 2021. Claims data was gathered from the Symphony Health database, “which includes 92% of US retail pharmacy claims, with race and ethnicity data spanning all insurance status and payer categories.”

Included in the study were 1,556,860 people who filled buprenorphine prescriptions and 127,506 people who filled naltrexone prescriptions.

Clinician-reported demographic data showed 4359 (.3%) Asian individuals, 94,657 (6.1%) Black individuals, 55,369 (3.6%) Hispanic individuals, and 664,779 (42.7%) White individuals received buprenorphine during the study period. Filling prescriptions for extended-release naltrexone were 344 (.3%) Asian individuals, 8186 (6.4%) Black individuals, 5343 (4.2%) Hispanic individuals, and 53,068 (41.6%) White individuals.

The rate of filled buprenorphine prescriptions was on the rise before the pandemic, but this trend flattened across groups when COVID-19 hit (30.5% difference in trend; P<.001).

Researchers found significant decreases in buprenorphine fills at the onset of the pandemic for those in racial and ethnic minority groups but not for White individuals. Stratified by payment type, those who filled prescriptions through Medicare or cash payments saw decreases in buprenorphine fill rates, with greater decreases for Black individuals (Medicare: 10%; P<.001; cash: 20%; P<.001) than White individuals (Medicare: 3.5%; P=.004; cash: 15%; P<.001). Fill rates did not decrease for individuals with Medicaid.

Investigators found naltrexone fill rates decreased as well, although there were no significant disparities in trend between groups.

“This greater disruption in filled buprenorphine and naltrexone prescriptions among racial and ethnic minority groups is concerning given that rates of fatal overdoses among these subpopulations have increased rapidly,” researchers wrote.

“The COVID-19 pandemic may have been associated with exacerbated financial barriers to buprenorphine and naltrexone for OUD among racial and ethnic minority groups, who have experienced greater economic losses during the pandemic,” study authors concluded. “Policies like eliminating buprenorphine waiver requirements and providing necessary training to physicians and advanced practitioners in primary care settings may have helped improve availability.”

Reference:
Nguyen T, Ziedan E, Simon K, et al. Racial and ethnic disparities in buprenorphine and extended-release naltrexone filled prescriptions during the COVID-19 pandemic. JAMA Netw Open. 2022;5(6):e2214765. doi:10.1001/jamanetworkopen.2022.14765