Racial Discrepancies in Opioid Overdoses and Buprenorphine Access in Philadelphia

RESEARCH ANALYSIS

Racial Discrepancies in Opioid Overdoses and Buprenorphine Access in Philadelphia

KATHERINE CHAMBERS, BS

Lewis Katz School of Medicine

SUMMARY POINTS

-       There was a disproportionate increase in opioid overdose deaths among Black Philadelphians from 2018-2022, while deaths in the white population are falling. This increase is linked to the usage of a combination of opioids and stimulants.

-       The pandemic caused a decrease in buprenorphine prescription fills for Black and Latino patients.

-       Nationwide, Black patients are 42% less likely to receive a buprenorphine prescription after a diagnosis of OUD.

-       There are regional discrepancies in Philadelphia for access to buprenorphine prescriptions that is leading to a shortage for Black Philadelphians.

ANALYSIS

Background

In Philadelphia, overdose deaths are increasing at the sharpest rates for Non-Hispanic (NH) Black people, with the number of overdose deaths doubling from 2018 to 2022 (1). In White populations, the number of overdose deaths decreased by 20% in the same period, according to data from the Philadelphia Department of Public Health (1). These numbers are alarming, especially as harm reduction efforts and life saving interventions like naloxone and suboxone prescriptions continue to expand citywide.

Analysis

There are racial discrepancies in overdoses on a national level. Between 2021 and 2022, overdose rates fell among White populations but increased for Hispanic, Black, Asian, and American Indian populations (2).

Medical inequity is certainly a contributing factor to this issue. Getting into the provider's office is not the only barrier, as a retrospective analysis done in 2022 found that, among people diagnosed with opioid use disorder on Medicaid, non-Hispanic Black Americans were 42% less likely to receive buprenorphine prescriptions (3). This is a significant difference that highlights a nationwide inequity. This data demonstrates that Black patients are not receiving the same care options as their White counterparts. While this data does not specify whether buprenorphine was discussed or offered to these patients, these strong racial discrepancies suggest a divide in who receives this medication. Buprenorphine is a helpful, potentially life-saving medication, and the uncertainty for Black patients to receive it is a cause for serious concern.

During COVID-19, non-Hispanic Black Americans had the most reduced access to buprenorphine prescriptions. Before the pandemic, fill rates of buprenorphine were increasing for all three groups studied (Hispanic, non-Hispanic White, and Black Americans). While the pandemic caused a flattening of the fill curve for all three groups, there was an overall decrease of 2.5% and 4.0% in the filling of buprenorphine for Black Americans and Hispanic Americans, respectively (4). This is important to acknowledge and recognize as a contributing factor to the increasing overdose rates within the Black community.

Lack of prescription filling could also be due to a lack of supply. In Philadelphia, researchers found a pattern of fewer pharmacies that fill or stock buprenorphine in Black neighborhoods. There is a sentiment among some that zip codes like the 19140 (in North Philadelphia) are overlooked in the overdose crisis because Kensington draws the most attention. However, the overdose rates in Kensington are falling, from 209 deaths in 2017 to 169 deaths in 2021. In North Philadelphia (19140), a predominantly Black area, overdose deaths rose from 48 cases in 2017 to 84 cases in 2021 (5). Furthermore, these researchers found that there were 16 pharmacies that stock buprenorphine in Kensington, and only 2 in North Philly. This data identifies a massive inequity in buprenorphine access that could be contributing to the differential overdose rates by race.

Discussion

In conclusion, there is racial inequality in opioid use disorder treatment at the national and local level that makes it harder for Black Americans to receive buprenorphine. This is an urgent issue that needs to be addressed to help mitigate the overdose crisis, as overdose rates keep increasing for Black Americans. There are many reasons why healthcare is harder to access for Black Americans, such as to medical inequity and discrimination. However, identifying this specific gap is important so that programs and initiatives can become more effective. As physicians, it is our responsibility to be aware of these gaps in healthcare access and do our best to work on them.

In Philadelphia, there needs to be a greater effort to expand buprenorphine accessibility, specifically in Black neighborhoods. Furthermore, community-based education and outreach efforts will improve trust and understanding between patients and providers. These efforts, combined with continued advocacy for buprenorphine mandates in pharmacies, will make it possible for more Black Philadelphians to access buprenorphine and reduce rates of fatal overdoses.

REFERENCES

1. Department of Public Health. (2023, September). Unintentional Drug Overdose Fatalities in Philadelphia, 2022. Philadelphia Department of Public Health.

2. Spencer, M. R., Garnett, M. F., & Miniño, A. M. (2024, March 21). Products - Data Briefs - Number 491 - March 2024. CDC. Retrieved June 19, 2024, from https://www.cdc.gov/nchs/products/databriefs/db491.htm#section_3

3. Dunphy, C. C., Zhang, K., Xu, L., & Guy, G. P. (2022, November). Racial Ethnic Disparities of Buprenorphine and Vivitrol Receipt in Medicaid. Am J Prev Med, 63(5), 717-725. PubMedCentral. 10.1016/j.amepre.2022.05.006

4. Nguyen, T., Ziedan, E., Simon, K., Miles, J., Crystal, S., Samples, H., & Gupta, S. (2022, June). Racial and Ethnic Disparities in Buprenorphine and Extended-Release Naltrexone Filled Prescriptions During the COVID-19 Pandemic. JAMA Netw Open, 5(6). 10.1001/jamanetworkopen.2022.14765

5. Aronowitz, S. V., French, R., Schachter, A., Seeburger, E., O'Donnell, N., Perrone, J., & Lowenstein, M. (2024, May/June). Mapping Buprenorphine Access at Philadelphia Pharmacies. Journal of Addiction Medicine, 18(3), 269-273. doi: 10.1097/ADM.0000000000001284.