Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA.
Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
Subst Abuse Treat Prev Policy. 2022 May 25;17(1):41. doi: 10.1186/s13011-022-00457-3.
Opioid overdose remains a public health crisis in diverse communities. Between 2019 and 2020, there was an almost 40% increase in drug fatalities primarily due to opioid analogues of both stimulants and opioids. Medications for opioid use disorder (MOUD; e.g., buprenorphine) are effective, evidence-based treatments that can be delivered in office-based primary care settings. We investigated disparities in the proportion of national prescribers who have obtained a waiver issued to prescribe MOUD by demographic characteristics.
Data for the secondary data analyses were obtained from the Drug Enforcement Administration that maintains data on waivered MOUD prescribers across the US. Proportion of waivered prescribers were examined by ZIP code, race and ethnicity composition, socioeconomic status, insurance, and urban-rural designation using generalized linear mixed effects models.
Compared with predominantly Non-Hispanic White ZIP codes, other racially and ethnically diverse areas had a higher proportion of waivered buprenorphine prescribers. Differences in prescriber availability between predominant racial group was dependent on rurality based on the interaction found in our fitted model. In metropolitan areas, we found that predominantly Non-Hispanic White ZIP codes had a lower rate of waivered prescribers compared to predominantly Black/African American ZIP codes.
Our findings suggest that among AI/AN and Black/African American neighborhoods, availability of waivered prescribers may not be a primary barrier. However, availability of waivered prescribers and prescribing might potentially be an obstacle for Hispanic/Latinx and rural communities. Additional research to determine factors related to improving MOUD availability among diverse communities therefore remains vital to advancing health equity.
阿片类药物过量仍然是不同社区的公共卫生危机。在 2019 年至 2020 年期间，由于兴奋剂和阿片类药物的类似物导致药物致死人数几乎增加了 40%。阿片类药物使用障碍（MOUD；例如丁丙诺啡）药物是有效的、基于证据的治疗方法，可以在以办公室为基础的初级保健环境中提供。我们调查了按人口统计学特征获得 MOUD 处方豁免的全国处方者比例的差异。
二次数据分析的数据来自美国毒品执法管理局，该机构保存了全美豁免 MOUD 处方者的数据。使用广义线性混合效应模型，按邮政编码、种族和族裔构成、社会经济地位、保险和城乡指定，检查豁免处方者的比例。
与主要为非西班牙裔白人邮政编码相比，其他种族和族裔多样化的地区有更高比例的豁免丁丙诺啡处方者。基于我们拟合模型中发现的相互作用，主要种族群体之间的处方者可用性差异取决于农村性。在大都市区，我们发现主要为非西班牙裔白人邮政编码的豁免处方者比例低于主要为黑人/非裔美国人邮政编码。
我们的研究结果表明，在美洲原住民和非裔美国人社区中，豁免处方者的可用性可能不是主要障碍。然而，豁免处方者的可用性和处方可能是西班牙裔/拉丁裔和农村社区的障碍。因此，为了推进健康公平，仍然需要进行更多的研究来确定与改善不同社区 MOUD 可用性相关的因素。
