Racial and Ethnic Disparities in Buprenorphine and Extended-Release Naltrexone Filled Prescriptions During the COVID-19 Pandemic

Nguyễn, Thủy; Ziedan, Engy; Simon, Kosali; Miles, Jennifer; Crystal, Stephen; Samples, Hillary; Gupta, Sumedha

doi:10.1001/jamanetworkopen.2022.14765

Cited by 43 publications

(24 citation statements)

References 30 publications

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“…42,43 Maintaining telephone-only access may be one means of promoting equity in buprenorphine receipt, although broader efforts to address disparities are needed. 44,45 At the same time, these findings suggest that receipt of video telehealth may support retention among new patients. Rather than revoking telephone-only accesswhich would likely disrupt treatment for many patients and particularly groups with existing disparities-efforts to increase video access may be needed.…”

Section: Discussionmentioning

confidence: 75%

“…Racism and socioeconomic inequality have profoundly impacted OUD treatment and resulted in unequal buprenorphine access . Maintaining telephone-only access may be one means of promoting equity in buprenorphine receipt, although broader efforts to address disparities are needed . At the same time, these findings suggest that receipt of video telehealth may support retention among new patients.…”

Section: Discussionmentioning

confidence: 95%

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Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic

et al. 2022

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ImportanceThe coronavirus disease 2019 (COVID-19) pandemic prompted policy changes to allow increased telehealth delivery of buprenorphine, a potentially lifesaving medication for opioid use disorder (OUD). It is unclear how characteristics of patients who access different treatment modalities (in-person vs telehealth, video vs telephone) vary, and whether modality is associated with retention—a key indicator of care quality.ObjectivesTo compare patient characteristics across receipt of different treatment modalities and to assess whether modality was associated with retention during the year following COVID-19–related policy changes.Design, Setting, and ParticipantsThis cross-sectional study was conducted in the national Veterans Health Administration. Participants included patients who received buprenorphine for OUD during March 23, 2020, to March 22, 2021. Analyses examining retention were stratified by buprenorphine initiation time (year following COVID-19–related changes; prior to COVID-19–related changes).ExposuresPatient characteristics; treatment modality (at least 1 video visit, at least 1 telephone visit but no video, only in-person).Main Outcomes and MeasuresTreatment modality; 90-day retention.ResultsAmong 17 182 patients, 7094 (41.3%) were aged 30 to 44 years and 6251 (36.4%) were aged 45 to 64 years; 15 835 (92.2%) were male, 14 085 (82.0%) were White, and 16 292 (94.8%) were non-Hispanic; 6547 (38.1%) had at least 1 video visit, 8524 (49.6%) had at least 1 telephone visit but no video visit, and 2111 (12.3%) had only in-person visits. Patients who were younger, male, Black, unknown race, Hispanic, non–service connected, or had specific mental health/substance use comorbidities were less likely to receive any telehealth. Among patients who received telehealth, those who were older, male, Black, non–service connected, or experiencing homelessness and/or housing instability were less likely to have video visits. Retention was significantly higher for patients with telehealth compared with only in-person visits regardless of initiation time (for initiated in year following COVID-19–related changes: adjusted odds ratio [aOR], 1.31; 95% CI, 1.12-1.53; for initiated prior to COVID-19–related changes: aOR, 1.23; 95% CI, 1.08-1.39). Among patients with telehealth, higher retention was observed in those with video visits compared with only telephone for patients who initiated in the year following COVID-19 (aOR, 1.47; 95% CI, 1.26-1.71).Conclusions and RelevanceIn this cross-sectional study, many patients accessed buprenorphine via telephone and some were less likely to have any video visits. These findings suggest that discontinuing or reducing telephone access may disrupt treatment for many patients, particularly groups with access disparities such as Black patients and those experiencing homelessness. Telehealth was associated with increased retention for both new and continuing patients.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 95%

Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic

et al. 2022

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“…Third, the race/ethnicity of the patients were not available in the IQVIA data sets used in the study. The literature has shown the impact of the COVID-19 pandemic to be more pronounced among people of color ( Shim & Starks, 2021 ), and examining racial/ethnic differences in buprenorphine prescriptions during the pandemic will be an important direction for future studies ( Nguyen, Ziedan, Simon, et al, 2022 ). Fourth, our study was not able to distinguish between buprenorphine treatment initiation vs continuation.…”

Section: Discussionmentioning

confidence: 99%

National trends in buprenorphine prescribing before and during the COVID-19 pandemic

Ali¹,

Creedon²,

Jacobus-Kantor³

et al. 2023

Journal of Substance Abuse Treatment

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“…32,33 Finally, the finding that a larger proportion of buprenorphine-involved overdose deaths, compared with other opioid-involved overdose deaths, were White non-Hispanic persons, may reflect lower rates of buprenorphine treatment among Black and Hispanic individuals. 34,35 Disproportionate increases in overdose death rates have been reported among American Indian, Alaska Native, and Black persons compared with White persons in counties with higher SUD treatment availability. 36 This may reflect treatment access barriers, including mistrust in the health care system, stigma, transportation access, and insurance status.…”

Section: Jama Network Open | Substance Use and Addictionmentioning

confidence: 99%

Trends and Characteristics of Buprenorphine-Involved Overdose Deaths Prior to and During the COVID-19 Pandemic

et al. 2023

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ImportanceBuprenorphine remains underused in treating opioid use disorder, despite its effectiveness. During the onset of the COVID-19 pandemic, the US government implemented prescribing flexibilities to support continued access.ObjectiveTo determine whether buprenorphine-involved overdose deaths changed after implementing these policy changes and highlight characteristics and circumstances of these deaths.Design, Setting, and ParticipantsThis cross-sectional study used data from the State Unintentional Drug Overdose Reporting System (SUDORS) to assess overdose deaths in 46 states and the District of Columbia occurring July 2019 to June 2021. Data were analyzed from March 7, 2022, to June 30, 2022.Main Outcomes and MeasuresBuprenorphine-involved and other opioid-involved overdose deaths were examined. Monthly opioid-involved overdose deaths and the percentage involving buprenorphine were computed to assess trends. Proportions and exact 95% CIs of drug coinvolvement, demographics, and circumstances were calculated by group.ResultsDuring July 2019 to June 2021, 32 jurisdictions reported 89 111 total overdose deaths and 74 474 opioid-involved overdose deaths, including 1955 buprenorphine-involved overdose deaths, accounting for 2.2% of all drug overdose deaths and 2.6% of opioid-involved overdose deaths. Median (IQR) age was similar for buprenorphine-involved overdose deaths (41 [34-55] years) and other opioid–involved overdose deaths (40 [31-52] years). A higher proportion of buprenorphine-involved overdose decedents, compared with other opioid–involved decedents, were female (36.1% [95% CI, 34.2%-38.2%] vs 29.1% [95% CI, 28.8%-29.4%]), non-Hispanic White (86.1% [95% CI, 84.6%-87.6%] vs 69.4% [95% CI, 69.1%-69.7%]), and residing in rural areas (20.8% [95% CI, 19.1%-22.5%] vs 11.4% [95% CI, 11.2%-11.7%]). Although monthly opioid-involved overdose deaths increased, the proportion involving buprenorphine fluctuated but did not increase during July 2019 to June 2021. Nearly all (92.7% [95% CI, 91.5%-93.7%]) buprenorphine-involved overdose deaths involved at least 1 other drug; higher proportions involved other prescription medications compared with other opioid-involved overdose deaths (eg, anticonvulsants: 18.6% [95% CI, 17.0%-20.3%] vs 5.4% [95% CI, 5.2%-5.5%]) and a lower proportion involved illicitly manufactured fentanyls (50.2% [95% CI, 48.1%-52.3%] vs 85.3% [95% CI, 85.1%-85.5%]). Buprenorphine decedents were more likely to be receiving mental health treatment than other opioid–involved overdose decedents (31.4% [95% CI, 29.3%-33.5%] vs 13.3% [95% CI, 13.1%-13.6%]).Conclusions and RelevanceThe findings of this cross-sectional study suggest that actions to facilitate access to buprenorphine-based treatment for opioid use disorder during the COVID-19 pandemic were not associated with an increased proportion of overdose deaths involving buprenorphine. Efforts are needed to expand more equitable and culturally competent access to and provision of buprenorphine-based treatment.

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Racial and Ethnic Disparities in Buprenorphine and Extended-Release Naltrexone Filled Prescriptions During the COVID-19 Pandemic

Abstract: This cross-sectional study investigates disparities by race and ethnicity in disruptions to filled buprenorphine and naltrexone prescriptions for opioid use disorder associated with the COVID-19 pandemic.

Cited by 43 publications

References 30 publications

Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic

Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic

National trends in buprenorphine prescribing before and during the COVID-19 pandemic

Trends and Characteristics of Buprenorphine-Involved Overdose Deaths Prior to and During the COVID-19 Pandemic

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