The study uses critical race theory to examine disparities in the treatment of opioid use disorder

Opioid use disorder is an addiction crisis in the United States that has become increasingly fatal during the COVID-19 pandemic. To maintain access to life-saving treatment during the pandemic, federal drug agencies have relaxed requirements for physicians to treat these patients, including moving patient evaluations away from in-person tests to telemedicine.

This federal policy change focused primarily on buprenorphine, a highly effective treatment for opioid use disorder that is less stressful and stigmatizing than methadone, the other more popular but closely monitored treatment.

With a $2.5 million grant from the National Institutes of Health, researchers at the University of Washington will explore one of the most important questions about this emergency policy change: whether these changes helped another opioid crisis—; The unequal access of black and Latino patients to buprenorphine.

There are a lot of clinical champions these days who believe buprenorphine should be offered routinely in primary care for people with opioid use disorder, and this policy change helps. However, we have seen systematically that black and Hispanic patients were significantly less likely to have buprenorphine with less stigma than white patients. “

Emily Williams, Professor of Health Systems and Population Health, University of Washington School of Public Health

Williams and co-principal investigator Jessica Chen, assistant professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, want to know if this injustice has persisted, improved, or is likely to get worse under the new policies because telemedicine itself can be a barrier. front access. The researchers, who also have appointments at the Denver Seattle Center for Innovation for Veteran-Centered Value-Based Care, will use national data from US Veterans Affairs to explore this question.

“I primarily work in a chronic pain clinic,” Chen said. “We’ve known for a long time that pain is untreated among some ethnic minorities. It’s really clear.” “And what is becoming increasingly clear to us as a country is that opioid use disorder is a massive epidemic, and what I see is that the life-saving treatments we provide for opioid use disorder are also not gaining acceptance by patients of color and other minority groups.”

To understand how and why these disparities exist, researchers will make a unique study effort to use critical race theory and related public health practices developed by Chandra Ford, UCLA, and Collins Airhihenbuwa, Georgia State University, “to examine the structural mechanisms of disparities” in the treatment of opioid use disorder, as The researchers mentioned in the grant application.

“This position provides an excellent opportunity to begin applying critical race theory and the practice of ‘focusing margins’ in designing research that focuses on the experiences of marginalized populations,” Williams said. “A lot of research focuses on what happens to small groups compared to white people and then discovers those mechanisms. But when we focus on the margins, we really care about what happens to these small groups that don’t get what they need.”

The researchers plan to conduct telephone interviews with black and Latino patients for this part of the study. They intend to look beyond the health care system and into patient communities to learn more about the policies that society has instituted that affect them. For example, the War on Drugs is a policy initiated by President Nixon in 1971 that has variously affected small communities, including ways that act as barriers to proper treatment of drug abuse.

“One of the key variables that we’re looking at is the differential police presence in communities as one of the things that might modify community members’ ability to access buprenorphine versus methadone,” Chen said. “The more any particular behavior is criminalized, the more we can expect people to go through the court system and a course of treatment that involves a lot of monitoring, as methadone does. Then of course that same treatment becomes more and more disruptive in a person’s life, which then has implications for the family, As well as economic and professional opportunities.

The researchers hope their findings will show who has benefited from easier access to buprenorphine and whether these temporary policy changes to access should be made permanent. They also hope to encourage the larger health care system to review and change social policies that have such a significant impact on individual outcomes.

“There are so many awful and sad ways in which our society is built to limit access to resources for some groups and to differentiate other groups, and the way it flows into health care and in particular the care of stigmatized conditions like opioids,” Williams said. , heartbreaking.”