Opioid Addiction Drug Going Mostly To Whites, Even As Black Death Rate Rises


May 8, 20191:46 PM ET

Heard on All Things Considered


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Buprenorphine, better known by the brand name Suboxone, helps people with opioid addiction stay in recovery. But it is prescribed far more often to white drug users than to blacks.

Craig F. Walker/Boston Globe via Getty Images

White drug users addicted to heroin, fentanyl and other opioids have had near exclusive access to buprenorphine, a drug that curbs the craving for opioids and reduces the chance of a fatal overdose. That's according to a study out Wednesday from the University of Michigan. It appears in JAMA Psychiatry.

Researchers reviewed two national surveys of physician-reported prescriptions. Between 2012 and 2015, as overdose deaths surged in many states, so did the number of visits during which a doctor or nurse practitioner prescribed buprenorphine, often referred to by its brand name, Suboxone. The researchers assessed 13.4 million medical encounters involving the drug but found no increase in prescriptions written for African Americans and other minorities.

"White populations are almost 35 times as likely to have a buprenorphine-related visit than black Americans," says Dr. Pooja Lagisetty, an assistant professor of medicine at the University of Michigan Medical School and the study's corresponding author.

The dominant use of buprenorphine to treat whites occurred at the same time opioid overdose deaths were rising faster for blacks than for whites.

"This epidemic over the last few years has been framed by many as largely a white epidemic, but we know now that's not true," Lagisetty says.

What is true, Lagisetty added, is that most of the white patients either paid cash (40%) or relied on private insurance (35%) to fund their buprenorphine treatment. The fact that just 25% of the visits were paid for through Medicaid and Medicare "does highlight that many of these visits could be very costly for persons of low income," Lagisetty says.

Doctors and nurse practitioners can demand cash payments because there's a shortage of clinicians who can prescribe buprenorphine, according to Dr. Andrew Kolodny, co-director of Opioid Policy Research at Brandeis University. Only about 5% of physicians have taken the special training required to prescribe buprenorphine.

"The few that are doing it are really able to name their price, and that's what we're seeing here and that's the reason why individuals with more resources — who are more likely to be white — are more likely to access treatment with buprenorphine," says Kolodny, who was not involved in the study.

Kolodny wants the federal government to eliminate the required special training for buprenorphine and a related cap on the number of patients a doctor can manage on the drug.

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Some physicians who have studied racial disparities in addiction treatment say the root causes go back to 2000, when buprenorphine was approved. At that time, proponents argued that buprenorphine was needed to help treat suburban youth, says Dr. Helena Hansen at New York University. Those young patients didn't see themselves as addicted to heroin in the same way as hard-core urban heroin users who went to methadone clinics for treatment, she says.

"Buprenorphine was introduced as private office treatment, for a private market, with the means to pay," says Hansen, an associate professor of psychiatry and anthropology. "So the unequal dissemination of buprenorphine for opioid dependence is not accidental."

Hansen added that the fix must include universal access to treatment in a primary care setting, an end to the criminalization of opioid dependence (which puts more blacks in prison for drug use than whites), and more federal funding to expand access to buprenorphine for all patients.

Several leaders in the fight to reduce opioid overdose deaths say the study results are disturbing.

"It really demands for us to be looking at equitable treatment for addiction for African Americans as we do for white Americans," says Michael Botticelli, director of the Grayken Center for Addiction at Boston Medical Center and the former director of the Office of National Drug Control Policy.

Botticelli identified some key issues that may be contributing to the racial treatment gap that deserve further investigation. For example, he wants to know whether Medicaid reimbursement rates are simply too low to entice more doctors to work with low-income patients, or there are too few inner-city doctors prescribing buprenorphine, or African Americans themselves are somehow reluctant to seek this form of treatment.

Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, called the findings surprising and disturbing. Surprising because the disparity is so large, and disturbing because her agency has prioritized educating doctors about the value of prescribing buprenorphine.

Volkow also expressed disappointment that federal parity laws, which are supposed to guarantee equal access to all types of medications, don't seem to be working for buprenorphine. "We need to ensure that we have capacity to provide these treatments," Volkow says. "Because if you say you have to pay for them, but there are no services that can provide the treatments, then the issue of paying for them is secondary."

Volkow has noted that fewer than half of Americans with an opioid use disorder have access to buprenorphine or the two other medications used to treat opioid addiction: methadone and naltrexone. Volkow said she is glad that the use of buprenorphine is on the rise, but the U.S. needs to understand why this lifesaving treatment isn't benefiting all patients who need it.

This story is part of a reporting partnership that includes WBUR, NPR and Kaiser Health News.


Recovery Community Organizations in Medically Underserved Communities of Color

by Joe Powell

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A Recovery Community Organization (RCO) is an independent, non-profit organization led by persons in recovery, their family members, friends and allies. RCOs provide a combination of long-term peer-based recovery supports, community education, grassroots mobilization and advocacy to support recovery. The sole mission of an RCO is to mobilize resources within and outside of a community to increase the prevalence and quality of long-term recovery within a community (Valentine, White and Taylor, 2007).

 In 1998 SAMSHA funded 20 RCOs throughout the United States to advocate and educate communities about the long-term effects of recovery. It was in the same year that the Association of Persons Affected by Addiction (APAA) was founded by people from various backgrounds and experiences. We had one simple purpose and that was to spread recovery in Dallas Texas. Now 21 years later, we know through experience that the RCO model is ideal for African American communities impacted by addiction and co-occurring mental health challenges. Recovery flourishes in a community that is connected to a network of strength-based services; and that network thrives because of the experiential knowledge and lived experience of the people in recovery and allies.

While many African Americans receive services in traditional addiction treatment programs many of these programs offer acute care solutions to a chronic and progressive illness. Simply, they focus on the problem and the person’s weakness rather than their strengths and supports. Many of these programs are located outside of the black community and offer little to no continued cultural hope or recovery support upon discharge. It became clear that services were needed within the community to support recovery. APAA moved to Martin Luther King Jr. Blvd in the heart of a black community in Dallas. The first thing our RCO did was Map the entire community for recovery capital and champions. In the community there were churches, barbershops, police stations, grocery stores, community groups, 12 step meetings etc. We pulled the entire community together, bringing addiction out of the closet and we mobilized the community to support recovery. We viewed the entire community as the recovery center. We noted that there were many liquor stores in the community and no programs to support recovery. We started training and hiring recovery coaches within the community to support long term recovery. Treatment centers often lose funding and shut down. We have found that offering a peer-based solution in the black community is a great solution.

Federal, State, County and the city council is now involved in our recovery efforts. Our funding is now provided by various community groups who see the benefits of anchoring recovery in the community. While there is much work to do, we have a thriving recovering community in Dallas. We coordinated the 2016 National Recovery Celebration and look forward to hosting the 2019 Big Texas Rally for Recovery. 

About the Author

Joe Powell is the President and CEO of APAA a leading peer driven, peer led, and peer ran recovery community organization. He is recipient of the Vernon Johnson Award for advocacy. 

Implementing Cultural Competence in a Trauma Informed Setting for African-American Emerging Adults with Co-occurring Disorders

by Fred Dyer, PhD, CADC

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The aforementioned title of this post reminds those of us who are working with African American Emerging Adults with Co-occurring Disorders, and/or those who desire to, that due to the early exposure of Adverse Childhood Experiences (ACE'S) and their impact psychiactrically, behaviorally and developmentally, when working with African Emerging adults it is necessary to be able to respond to the trauma in their lives in a culturally competent/sensitive manner.

 Laura Brown{2008} reminds us of the importance of cultural competence  in trauma informed care by stating that "Healthcare delivery of services for emerging adults  cannot be all inclusive without embracing, the need  for cultural competence/sensitivity, and even the best practices lack efficacy when culture is not incorporated as a trauma-informed solution. Additionally failure to bring cultural competence to the table can lead to missteps in genuinely helping African American emerging Adult trauma survivors or worse can result in deepening the wounds of trauma, creating secondary and tertiary traumas that are more painful than the original because they are appraised by victims and survivors as unnecessary wounds.

 As with other important topics time nor space affords the appropriate amount of time to discuss. However any discussion/treatment of trauma must and should include: Historical trauma and culturally competent/ sensitive practice parameters for healing historical trauma.

The following are a few principles for implementing culturally competent/sensitive trauma informed -care with African- American emerging adults with co-occurring disorders. 1. connect clients with resources they trust including types of professionals and traditional healers, 2. help clients to restore a sense of safety, 3. connect clients with elders who lived thru traumatic events and who managed trauma, discrimination, and setbacks, 4. remember it is important to ask clients "what the event means to them. It is clear that addressing cultural competency and utilizing cultural sensitivity in a trauma -informed setting with African - American emerging adults with co-occurring disorders is no longer an exception, but rather an expectation.