Addiction Treatment Medicine Is Vastly Underprescribed, Especially by Race, Study Finds

Dr. Ayana Jordan, an addiction psychiatrist who teaches at the N.Y.U. Grossman School of Medicine and was not involved in the new research, said the study showed the result of many intertwined problems in addressing addiction, especially for Black patients.

She theorized that often physicians made automatic, unconscious assumptions about such patients: “ ‘They’re not going to participate fully in taking care of themselves, so why go through the motions or take the time, compared to a white patient, to go over everything?’ ”

Doctors often don’t emphasize the importance of the medication nor fully explain how to use it, Dr. Jordan continued. Even though most Black patients in this study were covered by Medicare and Medicaid, these medications can require a modest co-payment, she said. For patients struggling to afford food, transportation and shelter, even a small cash outlay for medicine can be a low priority. And, she added, studies show that such medications are not often readily available at pharmacies in poorer communities of color.

“I don’t want to blame doctors,” Dr. Jordan said. “I want to blame the system, because it’s one that promotes limited engagement with patients overall, one that’s even more limited when you’re dealing with Black people.”

In another finding causing concern, patients in the study filled prescriptions at higher rates for medications known to be life-threatening for people addicted to opioids than they filled prescriptions for the lifesaving medicines. Those problematic medications included painkillers and anti-anxiety drugs which, particularly in conjunction with street opioids, can slow breathing and blood pressure to dangerous levels.

Nearly a quarter of the patients filled prescriptions for opioid painkillers, a troubling finding because during encounters with doctors they had already indicated a dependence on opioids. Rates of filled prescriptions for benzodiazepines, like Xanax, Valium and Ativan, differed by race: 23.4 percent among Black patients, 29.6 percent among Latinos and 37.1 percent of white patients — all of which far exceeded rates of the patients’ acquisition of buprenorphine.

“A lot of these patients have chronic pain, for which they are receiving opioids, and they might have mental health comorbidities like anxiety that they might be getting benzos for, ” Dr. Barnett said. “Very often these patients will end up with more than one controlled substance, sometimes to counteract side effects from another. It’s a complex mix. But we know for sure that these meds are a very bad combination together.” The researchers also looked at a separate database of prescriptions filled for methadone, an older treatment medication. From 2020 through 2021, those numbers were also very low across all races, ranging from 8 to 11 percent.

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