(40) Sociodemographic Factors and Medications for Opioid Use Disorder (MOUD) Initiation and Retention: A Review

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 714

Presenting Author(s)

Catherine Psaras
– University of California, Los Angeles, University of California, Los Angeles, Los Angeles, California, United States

Co-Author(s)

Sophia L. Balkovski
– University of California, Los Angeles
Marissa Seamans, PhD MSPH
– Assistant Professor, UCLA Fielding School of Public Health, United States

Background: While medication for opioid use disorder (MOUD) has been effective, treatment initiation has been a challenge.

Objectives: The objective of this study was to examine race/ethnicity and regional geographic factors associated with initiation and supply-side barriers to initiation for MOUD.

Methods: EMBASE and PubMed databases were searched for observational studies examining race/ethnicity, supply-side, and geographic correlates of MOUD initiation. Articles were examined, grouped by factors summarized, and findings were collated.

Results: Thirty-eight observational studies met the inclusion criteria for this review.

Non-white individuals were almost universally disadvantaged in initiating MOUD therapy, particularly buprenorphine therapy, despite on average residing closer to clinics than white patients. Fourteen studies utilizing data from electronic health records, public insurance, private insurance, and state and federal administrative records found disparities in MOUD treatment initiation. Buprenorphine was also less utilized by non-White patients.

The disparity in buprenorphine use among non-white patients in comparison to white patients may be due to lack of availability. Availability is a function of clinics, physicians possessing a waiver to prescribe buprenorphine, and waivered physician patient capacity to prescribe buprenorphine. According to the studies examined for this review, all these factors are lacking in non-White communities. One study postulated that this may be due in part to lack of physician resources to obtain waivers in already under-resourced areas. This leaves patients with the option of naltrexone or methadone from a specialty clinic.

Three studies reported on the distribution of buprenorphine and methadone providers in the United States. All noted that buprenorphine availability was not even across all states and regions. The Northeast, particularly Rhode Island, has the most methadone clinics per 100,000 population in 2019. Wyoming was the worst in terms of methadone availability. Conversely, in terms of buprenorphine, states west of the Mississippi exhibited the least access to treatment (Kansas, Nebraska, Iowa, and South Dakota).

Conclusions: There is strong evidence from this review that there are both race/ethnicity and regional disparities in MOUD initiation and supply-side barriers to initiation. The lack of buprenorphine availability in non-white communities is particularly troubling. There is growing evidence that naltrexone is not as effective as buprenorphine in preventing mortality from opioid overdose. If naltrexone is more often the only available medication for some communities, this presents a significant health equity issue. These findings warrant further research into the causes of these disparities to act quickly and efficiently via policy, physician education, or public health education.