Less than an hour later, Hargrove overdosed on a substance believed to be fentanyl and passed out in her sister’s Columbia Heights apartment. “Don’t tell me!” cried his sister. “You really tried hard!”
Hargrove’s story has led public health experts to believe that people suffering from opioid addiction, especially those of color, should play a key role in curbing the addiction and overdose crisis caused by fentanyl. It presents a challenge often encountered in administering buprenorphine, a commonly used therapeutic agent. Newly published national study from Harvard TH Chan School of Public Health finds that white patients are up to 80 percent more likely to receive buprenorphine than black patients, and black patients receive more limited doses. As indicated, his overdose occurred this month.
“There are a lot of insurance regulations that are utterly counterproductive to this drug, especially for the population with the greatest need,” said Michael, lead author of the study and associate professor of health policy and management at the Harvard School of Public Health. Mr. L. Burnett said. .
the study published A paper published in the New England Journal of Medicine found that between 2016 and 2019, nonfatal overdoses, injection-related infections, and opioid encounters that led to hospitalization and rehabilitation treatment We examined the medical records of more than 23,300 Medicare beneficiaries with disabilities. By the time he received treatment, more than 23 percent of his white patients had filled a prescription for buprenorphine, compared with less than 13 percent of his black patients. Nearly 19% of Hispanic residents received medication. The study did not measure whether prescriptions were written or whether prescriptions were not given.
This large study adds to the growing body of research reflecting racial disparities in pharmacological support for opioid addiction. last fall, analysis Fifteen years of prescribing data published in JAMA Psychiatry revealed that black and Hispanic patients were treated with buprenorphine for less time than white patients.
More than 100,000 Americans die each year from drug overdoses (mostly from opioids), including spike Mortality among African Americans.
“The system has the capacity to proactively treat chronic health problems, especially when it comes to substance use disorders, which African Americans do not,” says Population and Public Health at the University of Southern California Keck School of Medicine. Ricky Blusenthal, a professor of science who is not involved in substance use disorders, said. A recently published study.
In the Harvard study, researchers examined a random sample of Medicare beneficiaries diagnosed with the disorder, a group heavily affected by opioid addiction. The study also found that black and Hispanic patients were less likely to receive prescriptions for naloxone, a drug used to reverse an opioid overdose.
Another disturbing conclusion is that higher proportions of patients in all three racial or ethnic groups were prescribed opioid analgesics or benzodiazepines commonly used to treat anxiety than buprenorphine. is. These pain relievers and benzodiazepines can greatly increase the risk of overdose for people already addicted to opioids.
Experts say the disparities in buprenorphine use include a lack of healthcare providers willing to prescribe the drug, biased prescribing, mistrust of medical institutions, and longstanding racism in the U.S. healthcare system. , says there are many reasons.
Expanding pharmacotherapy for opioid addiction is the Biden administration’s plan strategy To combat the overdose crisis. It was first approved for the treatment of opioid addiction in 2002. buprenorphine Helps combat heroin cravings and withdrawal symptoms and increasingly addicted to illegal fentanyl.Last year, the federal government made easy With more doctors asking to prescribe the drug, the Drug Enforcement Administration extended a pandemic-era provision to allow doctors to prescribe buprenorphine via telemedicine.
Still, physicians inexperienced with buprenorphine may be reluctant to prescribe it. Stereotypes and implicit racial prejudices may prevent doctors from prescribing buprenorphine to black and Hispanic patients, said Oluwole Jegede, a professor of psychiatry at Yale University, who said patients were particularly likely to abuse buprenorphine. If doctors fear that the drug will be sold or the treatment will be unsuccessful, he said. Instead, patients of color could be given methadone, a stronger but more restricted addiction drug that has been allowed to be dispensed only in specialized clinics for 50 years. he said.
Dzegede called this a “two-class system” underpinned by false notions. “The data show that the fear of patients selling buprenorphine is not justified,” he says.
This claim was underscored by the inspector general of the Department of Health and Human Services report The researchers concluded this month that the risk of patients selling or giving away buprenorphine is extremely low.
Mario, a 26-year-old Mexican-American and former U.S. Army soldier, had never heard of buprenorphine. His addiction began with painkillers prescribed for a shoulder injury after a tank accident, then progressed to fentanyl as pills were no longer available after being discharged from the hospital.
He sought help at a Veterans Affairs hospital in Orange County, California. He was referred for treatment at a methadone clinic, but no one mentioned buprenorphine, Mario recalled. However, he was concerned that the methadone was too strong. Plus, he had to wait in line every day at a clinic in a tough neighborhood in his hometown of Santa Ana.
“I didn’t want to do that,” said Mario, who asked not to give his full name for fear of stigma. “What would you do if someone you know sees me there?”
He then learned about buprenorphine from another user. Mario said he called two clinics for a prescription and was denied without explanation, even though he had VA and California supplemental insurance. Mario said he was embarrassed when a white friend, also a former veteran but with a job and a stable home, got a prescription at the same clinic.
“At the time, I was living in a car,” said Mario, who is disabled and suffers from post-traumatic stress syndrome.
Mario eventually secured a prescription for buprenorphine through a telemedicine provider. He credits the drug with helping him quit fentanyl. After several months of use, he also stopped taking buprenorphine because he was concerned that he was still using an addictive drug.
His recognition is not unusual. Addiction experts say patients’ negative perceptions of buprenorphine may also contribute to the disparity.
A Harvard University study found that patients of all racial groups make similar visits to their health care providers. This means that disparities cannot necessarily be explained by fewer contacts with the health system. Last year, researchers at another research institute said study In in-depth interviews with 41 buprenorphine-naive Boston patients, black and Hispanic patients “expressed greater distrust” of drug therapy, with some quitting cold turkey and staying in groups. Or it turns out that some prefer to participate in lodging programs.
Jawad Hussein, Addiction Psychiatry Research Fellow at Mass General Brigham He of Boston and the study’s lead author said researchers found that black and Hispanic patients were more likely to view methadone and buprenorphine as alternatives to illicit opioids.
“No,” he said. “These drugs don’t get them high. They have a built-up tolerance that makes them feel normal again.”
Husain, like other addiction professionals, believes that educating a wider range of physicians, community groups and patients about medication-based treatments is key to breaking down barriers.
Even for doctors and patients who advocate buprenorphine, like Hargrove, the insurance system can impose barriers.
A affable former martial arts instructor, Hargrove suffers from mental illness and has spent most of the past 20 years living on the streets of Washington, DC. Decades ago, he said, he became dependent on the codeine pain reliever to deal with combat injuries.
About a decade ago, he consulted Edwin Chapman, 77, an addiction treatment doctor who treats mostly black patients outside the Capitol. He is known to be an ardent patient advocate, advocating for greater access to buprenorphine, while frequently sending e-mails to public officials warning them of the dangers of DC’s toxic drug supply.
“I’m still alive today because of him,” Hargrove said.
Chapman said Hargrove’s case illustrates a deep-seated problem for addiction doctors: insurance companies’ “pre-approval” policies are hampering treatment.Hargrove provides disability benefits, DC Medicaid, and Medicare Advantage, the insurance company contracts with Medicare. Hargrove’s previous policy covered four doses of 8 milligrams of buprenorphine a day for a month, and Hargrove visited Chapman’s office monthly to renew his prescription.
Hargrove recently switched to UnitedHealthcare. In March, Chapman and Hargrove said the company would only agree to dosing three times a day, meaning they would have to extend the supply for a month. “The first month was hell,” Hargrove said.
In a statement, UnitedHealthcare said Hargrove’s prescription was “filled in accordance with his plan’s benefits” and met Food and Drug Administration guidelines for the drug. “We didn’t get any documentation or other support from the provider to support the higher dose requirement,” the company said.
Chapman said the prescription recommendation was turned down by United pharmacies. “How can a pharmacist beat a doctor?” said Chapman.
Hargrove overdosed on a suspected fentanyl tablet on May 11, before he was cleared to receive a new prescription of three tablets a day. Inside his sister’s apartment, he fainted in his bedroom chair. The whites of his eyes turned gray. His sister, Claudette Inge, called 911 and frantically poured a glass of cold water in his face and began giving him chest compressions.
Paramedics used Narkan to resuscitate him. “I died in that chair,” Hargrove said of the scene the next day inside his sister’s apartment.
“This was really scary,” Dr. Chapman said. “I don’t want to see a stable patient become unstable for no reason at all because of bureaucracy.”
A day after the overdose, Hargrove finally got his hands on buprenorphine. “Just stretch as you’ve always done,” he told Chapman. speakerphone.
That afternoon, Hargrove walked into the Anacostia pharmacy, picked up the pills, pulled out a brown buprenorphine tablet, and popped it into his mouth. “You’ll feel better in about three minutes,” he said before heading to the bus stop.
He later learned that the insurance company had approved an extra daily dose in response to Chapman’s urgent appeal — it was after his fatal overdose.
