Medications for opioid use disorder among American Indians and Alaska natives: Availability and use across a national sample

Krawczyk, Noa; Garrett, Brady A.; Ahmad, N. Jia; Patel, Esita; Solomon, Keisha T.; Stuart, Elizabeth A.; Saloner, Brendan

doi:10.1016/j.drugalcdep.2021.108512

Cited by 22 publications

(15 citation statements)

References 21 publications

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“…These stressors often contribute significantly to the heightened drug use and related overdoses in the AI/AN population 13 15. Despite this disproportionate burden, Indigenous communities continue to encounter significant challenges in treatment access, availability32 and quality 33. A recent study using 2017 and 2018 data showed that only 22% of AI/AN-serving treatment centres offer opioid agonists.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study using 2017 and 2018 data showed that only 22% of AI/AN-serving treatment centres offer opioid agonists. Furthermore, they found that only 40% of AI/AN persons in specialty treatment receive medication-assisted treatment for opioid use disorder 32. To mitigate the impact of drug overdose on AI/AN communities, leverage points for intervention must look at the root causes and structural factors that shape substance use and addiction and seek to expand specialty treatment programmes for AI/AN communities.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiological trends in opioid-only and opioid/polysubstance-related death rates among American Indian/Alaska Native populations from 1999 to 2019: a retrospective longitudinal ecological study

et al. 2022

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ObjectivesThe rate of drug overdose deaths in the USA has more than tripled since the turn of the century, and rates are disproportionately high among the American Indian/Alaska Native (AI/AN) population. Little is known about the overall historical trends in AI/AN opioid-only and opioid/polysubstance-related mortality. This study will address this gap.DesignThis is a retrospective longitudinal ecological study.SettingUS death records from 1999 to 2019 using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research.ParticipantsUS non-Hispanic AI/AN people age 12 years and older.MeasuresThe primary outcomes, identified via the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes, included overdose deaths due to (1) opioids only, opioids in combination with any other substance, all-opioid related overdoses; (2) combinations of opioids and alcohol, opioids and methamphetamine, opioids and cocaine, opioids and benzodiazepines; and (3) specific types of opioids.ResultsFrom 1999 to 2019, opioid-only mortality rates increased from 2.8 to 15.8 per 100 000 (p<0.001) for AI/AN women and 4.6 to 25.6 per 100 000 (p<0.001) for AI/AN men. All opioid-related mortality rates increased significantly (p<0.001) from 5.2 to 33.9 per 100 000 AI/AN persons, 3.9 to 26.1 for women and 6.5 to 42.1 for men. AI/AN also exhibited significant increases in mortality rates due to opioids and alcohol, opioids and benzodiazepines, opioids and methamphetamine, and AI/AN men experienced substantial increases in mortality due to opioids and cocaine. Mortality rates by individual opioid types increased significantly over time for heroin, natural and semi-synthetic (prescription), and synthetic opioids (fentanyl/fentanyl analogues) other than methadone.ConclusionsThese findings highlight magnification over time in opioid-related deaths and may point to broader systemic factors that may disproportionately affect members of AI/AN communities and drive inequities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidemiological trends in opioid-only and opioid/polysubstance-related death rates among American Indian/Alaska Native populations from 1999 to 2019: a retrospective longitudinal ecological study

et al. 2022

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“…Our findings are supported by previous research that assessed potential access to prescribers among AI/AN communities, with results indicating there were a similar number of prescribers in AI/AN communities as in non-AI/AN areas [ 36 ]. Likewise, a recent study using a national treatment dataset determined that facilities serving AI/AN adults offered some medications at similar rates as facilities serving non-AI/AN clients, but were less likely to deliver standard treatment (i.e., methadone, buprenorphine; 22.4% vs 27.6%, p < 0.001) [ 37 ]. The relatively high availability of waivered prescribers may be the result of concerted efforts by Indian Health Service and other funding agencies such as the Substance Abuse and Mental Health Agency to improve treatment for this patient population.…”

Section: Discussionmentioning

confidence: 99%

Variations in national availability of waivered buprenorphine prescribers by racial and ethnic composition of zip codes

Hirchak

Amiri

Kordas

et al. 2022

Subst Abuse Treat Prev Policy

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Background Opioid overdose remains a public health crisis in diverse communities. Between 2019 and 2020, there was an almost 40% increase in drug fatalities primarily due to opioid analogues of both stimulants and opioids. Medications for opioid use disorder (MOUD; e.g., buprenorphine) are effective, evidence-based treatments that can be delivered in office-based primary care settings. We investigated disparities in the proportion of national prescribers who have obtained a waiver issued to prescribe MOUD by demographic characteristics. Methods Data for the secondary data analyses were obtained from the Drug Enforcement Administration that maintains data on waivered MOUD prescribers across the US. Proportion of waivered prescribers were examined by ZIP code, race and ethnicity composition, socioeconomic status, insurance, and urban–rural designation using generalized linear mixed effects models. Results Compared with predominantly Non-Hispanic White ZIP codes, other racially and ethnically diverse areas had a higher proportion of waivered buprenorphine prescribers. Differences in prescriber availability between predominant racial group was dependent on rurality based on the interaction found in our fitted model. In metropolitan areas, we found that predominantly Non-Hispanic White ZIP codes had a lower rate of waivered prescribers compared to predominantly Black/African American ZIP codes. Conclusions Our findings suggest that among AI/AN and Black/African American neighborhoods, availability of waivered prescribers may not be a primary barrier. However, availability of waivered prescribers and prescribing might potentially be an obstacle for Hispanic/Latinx and rural communities. Additional research to determine factors related to improving MOUD availability among diverse communities therefore remains vital to advancing health equity.

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“…In 2020, the rate of opioid overdose death among indigenous people was 27.4 per 100,000 individuals 30,31. Nonetheless, fewer than 30% of Native Americans diagnosed with substance abuse are offered treatment 32. And although the effects of the opioid epidemic in Native Americans are disproportionate, this population receives little attention in public health discussions and research.…”

Section: Racial and Ethnic Distribution Of Opioid Use Disorder And Re...mentioning

confidence: 99%

Racial inequities in opioid use disorder management: can the anesthesiologist improve outcomes?

Alalade

Willer

2022

International Anesthesiology Clinics

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Medications for opioid use disorder among American Indians and Alaska natives: Availability and use across a national sample

Cited by 22 publications

References 21 publications

Epidemiological trends in opioid-only and opioid/polysubstance-related death rates among American Indian/Alaska Native populations from 1999 to 2019: a retrospective longitudinal ecological study

Epidemiological trends in opioid-only and opioid/polysubstance-related death rates among American Indian/Alaska Native populations from 1999 to 2019: a retrospective longitudinal ecological study

Variations in national availability of waivered buprenorphine prescribers by racial and ethnic composition of zip codes

Racial inequities in opioid use disorder management: can the anesthesiologist improve outcomes?

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