(44) Trends in Buprenorphine Treatment Disparities During the COVID Pandemic in Massachusetts

Objectives: Racial, sex, and age disparities in buprenorphine have previously been demonstrated. We evaluated whether treatment disparities persisted since the COVID pandemic in Massachusetts.

Methods: This cross-sectional study used data from an integrated health system comparing 12-months before and after the March 2020 COVID stay-at-home order, excluding March as a washout period. Among patients with a clinical encounter during the study periods with a diagnosis of OUD or opioid poisoning, we extracted outpatient buprenorphine prescription rates by age, sex, race, ethnicity, and language. Generating a multivariable logistic regression model, we calculated the adjusted probability of receiving buprenorphine.

Results: Among 4,503 patients seen in the pre-COVID period, 61.1% received buprenorphine. Among 3,643 patients seen post-COVID, 58.9% received buprenorphine. Younger patients ( <24) had lower odds of receiving buprenorphine in both time periods (adjusted odds ratio (aOR), 0.42; 95% CI, 0.28-0.62 before vs aOR, 0.67; 95% CI, 0.47-0.96 after). Black patients had lower odds of receiving buprenorphine compared to White patients in both time periods (aOR, 0.75; 95% CI, 0.57-0.99 before vs aOR, 0.67; 95% CI, 0.49-0.90 after). Non-English speaking patients had lower odds of buprenorphine in the post-COVID time period (aOR, 0.64; 95% CI, 0.39-1.05 vs. aOR 0.56; 95% CI, 0.32-0.99). Male patients had higher odds of receiving buprenorphine in the post-COVID time period (aOR: 1.12; 95% CI, 0.99-1.27 vs aOR: 1.21; 95% CI, 1.05-1.39).

Conclusions: Younger, Black, non-English speaking, and female patients were less likely to be treated with buprenorphine since the COVID pandemic across an integrated health system in Massachusetts. These findings could indicate that when healthcare resources become scarce, as during the COVID pandemic, historically marginalized populations suffer a disproportionately greater burden in decreased treatment access. findings build on previous studies demonstrating racial, sex, and age disparities in buprenorphine treatment for OUD. These findings are particularly worrisome and timely given rising rates of opioid-related overdose mortality among Black individuals since the onset of the COVID pandemic. With rising rates of opioid-related overdose and racial disparities in overdose mortality, urgent policy initiatives and research efforts are needed to expand treatment access to historically marginalized populations and to further explore the etiology of racism and other inequities in buprenorphine treatment access across the United States.

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