People in impoverished neighborhoods struggle to access drug addiction medication, study finds

Buprenorphine is among three medications used to treat opioid addiction. (Joe Raedle Getty Images)

Patients battling addiction may struggle to fill their prescription for an opioid use disorder at their local pharmacy if they live in a low-income neighborhood or minority community, according to a new national study led by an Oregon State University researcher.

The study, also led by a researcher from John Hopkins University, underscores disparities in the health care system that dispenses life-saving medication amid a national epidemic of overdoses. In Oregon, nearly 1,400 people died of opioid overdoses in 2023, up from 280 in 2019, according to Oregon Health Authority data.

Nationwide, more than 100,000 people died of overdoses, three-quarters of which involved opioids. The fatalities disproportionately impact communities of color, including Black and Hispanic people. Their overdose fatality rates have nearly tripled in the last decade, compared to a 58% increase among white people, said the study , which was published in Drug and Alcohol and Dependence Reports.

“While there have been notable policy changes over the past decade that have improved access to meds used for opioid use disorder and made headway against racial disparities, those efforts haven’t taken into consideration the issue of whether patients can actually get their prescription filled,” said study co-author Dan Hartung, a researcher and professor who teaches at the OSU College of Pharmacy and Oregon Health & Science University.

Fentanyl is a synthetic opioid that can be legally prescribed to relieve severe pain. But fentanyl, which is highly addictive and lethal, also is illegally manufactured and sold on the streets, often after it is mixed with other drugs to make them more addictive.

The prescription drug buprenorphine offers people a chance to recover. The drug helps reduce pain and cravings during withdrawal from opioids, and it reduces the risk of death from overdose.

But to access that care, people need treatment – including a prescription and a pharmacy that will dispense it.

“It’s a life-saving medication,” Hartung said. “It’s difficult enough to find prescribers of these therapies. But then you have to find a pharmacy, and then you have to make sure that pharmacy is going to dispense it. So there’s multiple barriers facing patients with addiction.”

The researchers looked at data from telephone calls to 858 pharmacies in 473 counties across the United States. In each instance, the caller contacted a pharmacy and asked about getting a buprenorphine prescription filled.

Overall, about 20% of pharmacies were not able to provide the medication, Hartung said. But pharmacies in low-income neighborhoods were more than two times as likely to restrict access compared to privileged areas, he said.

Oregon pharmacies played a small role in the study’s findings. Just 6% of polled pharmacies – about 54 – were located in the West, including Oregon. But the findings still underscore the need for access to the medication in Oregon, especially as small pharmacies shutter in rural areas, Hartung said.

There are multiple potential reasons for the pharmacies’ inability to dispense. Buprenorphine distribution is regulated by the Drug Enforcement Agency, and pharmacists may be cautious about how much of the drug they purchase from wholesalers to avoid triggering an investigation. Pharmacies, especially independent ones with fewer resources, may stock less because of the costs.

The history of medication for opioid addiction treatment has racial underpinnings. In the 1960s, methadone – also a medication for treatment – came into use in urban areas seeking to combat crime, the study said. Amid that era of heightened civil unrest, those programs commonly were started in neighborhoods with people of color, the study said.

Buprenorphine, however, developed during the opioid overdose epidemic tied to prescription drugs. The Food and Drug Administration in 2002 approved its use to treat opioid addiction. With that action, physicians in offices could write prescriptions for buprenorphine and it reached white middle-class patients, the study said. The result: White patients are about four times more likely to receive buprenorphine as Black patients.

“These pharmacy dispensing barriers have the potential to exacerbate inequities in access to treatment,” Kyle Moon, a researcher at John Hopkins University, said in a statement. “And it shows that future policy interventions aimed at improving health care equity need to target dispensing capacity to augment the ones already put in place that make it easier for providers to prescribe buprenorphine.”

In Oregon, lawmakers passed House Bill 4002 , which allows counties to set up programs to help people in addiction get help rather than face criminal drug possession charges and jail time. The bill also makes changes intended to help people access medication to treat addiction.

For example, the bill blocks insurers from asking for time to review the claim for a prescription before approving treatment, a process called prior authorization that can delay the dispensing of medication. The bill also gives pharmacists more flexibility to dispense early refills.

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