Trends in Buprenorphine Treatment Disparities during the COVID Pandemic in Massachusetts

Wakeman, Sarah E.; Lambert, Eugene; Kung, Sunny; Brisbon, Nicholas M.; Carroll, Aleta D.; Hickman, Thu-Trang T.; Covahey, Charles; Sequist, Thomas D.; Weiner, Scott G.

doi:10.1080/08897077.2022.2095077

Cited by 5 publications

(3 citation statements)

References 24 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: 90%

“…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: 90%

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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“…Further compounding these challenges, the same individuals who face racism, incarceration, lack of housing, or other structural inequalities, are disproportionately harmed by barriers within the OUD care system. 29 – 32 …”

Section: Maximally Disruptive Carementioning

confidence: 99%

Envisioning Minimally Disruptive Opioid Use Disorder Care

Englander

Gregg²,

Levander

2022

J GEN INTERN MED

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Most people who need and want treatment for opioid addiction cannot access it. Among those who do get treatment, only a fraction receive evidence-based, life-saving medications for opioid use disorder (MOUD). MOUD access is not simply a matter of needing more clinicians or expanding existing treatment capacity. Instead, many facets of our health systems and policies create unwarranted, inflexible, and punitive practices that create life-threatening barriers to care. In the USA, opioid use disorder care is maximally disruptive. Minimally disruptive medicine (MDM) is a framework that focuses on achieving patient goals while imposing the smallest possible burden on patients’ lives. Using MDM framing, we highlight how current medical practices and policies worsen the burden of treatment and illness, compound life demands, and strain resources. We then offer suggestions for programmatic and policy changes that would reduce disruption to the lives of those seeking care, improve health care quality and delivery, begin to address disparities and inequities, and save lives.

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A Scoping Review of the Utilization of Opioid Use Treatment, Harm Reduction, and Culturally Tailored Interventions Among Racial/Ethnic Minorities in the United States

Ezell,

Simek,

Shetty

et al. 2024

Int J Ment Health Addiction

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As part of a multilayered scoping review, we assessed literature on prevention and management interventions for racial/ethnic minorities in the United States (US) who non-medically use prescription opioids and/or who use illicit opioids such as heroin. The review specifically focused on access to and uptake of medications for opioid use disorder (MOUD) and harm reduction resources. We conducted a scoping review of peer-reviewed literature and governmental reports published between January 2000 and August 2024 on patterns of access to, and acceptability and utilization of, overdose prevention and opioid use management resources among racial/ethnic minorities in the US. Searches were conducted on Cochrane, PubMed, Embase, and Google Scholar, with us examining studies on the uptake of MOUD, such as buprenorphine and methadone, syringe services programs (SSPs), safe consumption sites, and harm reduction resources like naloxone (used to reverse overdoses) and fentanyl test strips (used to test for the presence of fentanyl in drug supplies). Additionally, we sought to identify and describe existing interventions for opioid use prevention and management that have expressly incorporated cultural adaptations related to racial/ethnic minorities’ specific needs and preferences in an effort to improve participants' sense of salience and acceptability and thus enhance utilization. We further endeavored to leverage this scoping review towards the development of research and intervention guidelines contoured to improve future scholarship and programming with these populations. The existing evidence suggests that racial/ethnic minorities in the US, specifically Black individuals, have diminished access to and/or utilization of preventive and management resources and amenities such as buprenorphine and naloxone, owing to structural deficits, provider bias, socioeconomic obstacles, geographic barriers, and communal stigma and distrust. Black individuals, relative to White individuals, also appear less likely to report using SSPs to obtain syringes and related resources, but across racial groups, those who used SSPs were more likely to be trained in, possess, and/or use naloxone. Further, there have been very few culturally tailored interventions for harm reduction or MOUD; there were limited data across the reviewed works on Native American/Indigenous or Asian populations; and the broader body of literature lacks methodological rigor. We close by proposing a cultural humility-focused model for better meeting the complex needs of these populations through research and primary and secondary intervention.

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Trends in Buprenorphine Treatment Disparities during the COVID Pandemic in Massachusetts

Cited by 5 publications

References 24 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

Envisioning Minimally Disruptive Opioid Use Disorder Care

A Scoping Review of the Utilization of Opioid Use Treatment, Harm Reduction, and Culturally Tailored Interventions Among Racial/Ethnic Minorities in the United States

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