PORTLAND, Oregon – Patients with a prescription for an opioid use disorder medication may have difficulty getting it filled if their pharmacy is located in a community that is racially and economically segregated, according to a new study led by researchers at Oregon State University and Johns Hopkins University.
The findings shed additional light on health care disparities as the U.S. overdose crisis worsens, with death rates rising fastest among black and Hispanic/Latino populations.
“Although there have been notable policy changes over the past decade that have improved access to opioid addiction medications and made progress in combating racial discrimination, these efforts have not addressed whether patients are actually getting their prescriptions filled,” said study co-author Dan Hartung, who is at both the OSU College of Pharmacy and Oregon Health & Science University.
Over the past decade, overdose deaths have nearly tripled in these populations, while they have increased by 58% among whites.
According to the Centers for Disease Control and Prevention, more than 640,000 Americans died from an opioid overdose between 1999 and 2021. In 2022 alone, more than 100,000 people lost their lives to an overdose, and 75% of those deaths involved an opioid.
An important tool for recovery from opioid addiction is the prescription drug buprenorphine. It binds to the opioid receptors in the brain and spinal cord, producing similar but weakened effects as hydrocodone, oxycodone, morphine and fentanyl.
Treatment with buprenorphine, which relieves pain, cravings, withdrawal symptoms and ultimately the risk of overdose, reduces the risk of death from overdose by 50%, according to Hartung and Kyle Moon of Johns Hopkins University.
Similar to other opioids, the distribution of buprenorphine is overseen by the Drug Enforcement Agency. That can lead pharmacies to be extra cautious about how much of the drug they buy from wholesalers, who are required to report orders they find suspicious to the agency. Innocent or not, a DEA investigation can have devastating consequences for pharmacies, the researchers point out.
Previous studies have shown that fewer than one in five people diagnosed with opioid use disorder receive any type of medication therapy, and that white patients are about four times more likely to receive buprenorphine than non-white patients.
Hartung, Moon and collaborators at OSU, OHSU, Johns Hopkins and the Boise VA Medical Center analyzed data from a telephone audit of 858 pharmacies in 473 counties across the United States. In the audit, someone called each pharmacy and asked if they could fill a buprenorphine prescription.
The analysis found that in counties with the highest levels of racial and economic segregation, pharmacies were more than twice as likely to restrict their dispensing of buprenorphine as those in the most “economically privileged” counties.
“These barriers to drug dispensing in pharmacies could exacerbate inequities in access to treatment,” Moon said. “And it shows that future policies to improve health equity must target dispensing capacity to expand the capacity that already exists to make it easier for providers to prescribe buprenorphine.”
Adriane Irwin of the OSU College of Pharmacy contributed to the study, which was published in Drug and Alcohol and Dependence Reports.
