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Addiction Treatment Expands, but Remains Unequal

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Key Takeaways

  • Medicaid patients who received medication treatment for opioid use disorder (OUD) rose from 47.8% in 2014 to 57.1% in 2018. 
  • Black Medicaid patients were significantly less likely than their White counterparts to be treated with medication for OUD and less likely to have had continuity of care with treatment.
  • Pregnant Medicaid patients were more likely to receive continuous medication-assisted treatment to manage OUD.

State-funded Medicaid programs provide crucial support and services for low-income Americans in need of healthcare and, in recent years, have proved incredibly effective in helping those with opioid addiction. Still, gaps in accessibility remain.

A recent large-scale meta-analysis of Medicaid recipients published in JAMA found that while access to care has expanded in general, Black patients were receiving medication for OUD at a much lower rate than their White counterparts. This signals a pressing need for further evaluation of equitable treatment distribution along racial lines.

Understanding the Research

This Medicaid Outcomes Distributed Research Network (MODRN) study was based on over a million patients in 11 states and found medication use for the treatment of OUD increased from 47.8% in 2014 to 57.1% in 2018.

To determine the quality of care, researchers assessed for one period of continuous medication for 6 months, one urine drug test order, and one behavioral health counseling claim, as well as if any other controlled substances linked to increased overdose risk had been prescribed.

Pregnant Medicaid patients were more likely to be prescribed medication as part of their treatment to manage OUD, especially given how they tend to be followed during their pregnancy. Lower OUD medication use was found in terms of treatment among patients who were Black or disabled.

A limitation of this study was only covering 11 states but it included Pennsylvania and 5 other states with the highest opioid overdose deaths.

Minority Populations are Disproportionately Impacted

Addiction physician and researcher for the University of Calgary and the University of Alberta, S. Monty Ghosh, MD, MBT, MSc, BSc, FRCPC, ISAM, says, “The biggest takeaway is something we have known for a long time that exists in other disease states as well. Minority populations are disproportionately affected by the opioid crisis for various reasons, and access and maintenance to care is a key aspect to this impact.”

Given that inequitable addiction treatment access continues, Ghosh highlights the importance of involvement from the impacted communities. “By working with these communities and understanding their barriers and facilitators, we are more likely to understand how best to provide resources for them and address health inequity,” he says.

S. Monty Ghosh, MD, MBT, MSc, BSc, FRCPC, ISAM

Many populations are struggling with essential services such as housing, income, and food insecurity which makes their health needs secondary to survival.

— S. Monty Ghosh, MD, MBT, MSc, BSc, FRCPC, ISAM

Black Medicaid patients were significantly less likely to be treated with medications for OUD and were less likely to have continuity of such treatment, while pregnant women were much more likely to receive continuity of care with medication-assisted treatment for OUD.

Research has long demonstrated how trauma is connected to addictions, and BIPOC individuals are at high risk of negative events due to oppression, so inequitable addiction treatment access has far-reaching implications.

Ghosh says, “There are many barriers for vulnerable populations and marginalized communities to access care. Many populations are struggling with essential services such as housing, income, and food insecurity which makes their health needs secondary to survival. Interestingly with addiction, substances often hijack the parts of the brain that are entrenched to survival which is why individuals prioritize substance use.”

The Health Disparity Crisis

A faculty member in Walden University’s Master of Science in Nursing program, Deidra Thompson, DNP, FNP-C, PMHNP-BC, says, “Opioid use disorder has a significant impact on individuals and their families. People die daily from opioid use disorder. This is a crisis. Health disparities exist in several aspects of health care, including access to care and health outcomes.”

Deidra Thompson, DNP, FNP-C, PMHNP-BC

People die daily from opioid use disorder. This is a crisis. Health disparities exist in several aspects of health care, including access to care and health outcomes.

— Deidra Thompson, DNP, FNP-C, PMHNP-BC

Unfortunately, BIPOC individuals continue to disproportionately die from heart disease and avoidable conditions. “While the environment, socioeconomic status, and lifestyle can affect one’s health and access to care, disparities still exist even when these factors are controlled,” she says.

Thompson says, “Health care providers and policymakers are in positions to take action to decrease the gaps in health care by ensuring that quality care is provided to every patient regardless of race, gender, or status. We need greater awareness and more resources. Patients should be active in the development of their treatment plan and comply with treatment recommendations. Opioid use disorder is a disease.”

What This Means For You

Institutional racism and the stigma of addictions contribute to healthcare disparities for Black Medicaid patients struggling with OUD. Since Medicaid eligibility requires low incomes, the impact of poverty on these dynamics cannot be ignored. Given that pregnant Medicaid patients were more likely to receive continuous medication-assisted treatment to manage OUD, such success is possible for other groups.

It is why Ghosh says, “Readers can apply this by being as supportive of this population as possible and recognizing they have less access to resources and services and providing understanding that this may be a concern. It demonstrates that we need to be creative and innovative in bringing services to marginalized and vulnerable communities. Typical approaches often do not work so flexibility and creativity are key.”

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  1. The Medicaid Outcomes Distributed Research Network (MODRN), Brown E, Schutze M, et al. Use of medications for treatment of opioid use disorder among US Medicaid enrollees in 11 States, 2014-2018JAMA. 2021;326(2):154. doi:10.1001/jama.2021.7374