BLOOMINGTON, Ind. - A new study published in the Journal of the American Medical Association (JAMA) Network Open shows that the COVID-19 era worsened racial and ethnic disparities in the use of major medications to treat patients with opioid use disorder, a development that occurred while overdose death rates among Black individuals surpassed the rate for white individuals for the first time since 1999.

According to researchers at the Paul H. O’Neill School of Public and Environmental Affairs and colleagues at IUPUI, the University of Michigan, Tulane University, and Rutgers University, buprenorphine, a highly effective medication used to treat opioid use disorder, saw a decline of between 2.5-4 percent in filled prescriptions among Black, Hispanic and Asian patients, a drop that wasn’t mirrored among white patients. The study looked at data from the Symphony Health Database, which includes 92 percent of all U.S. retail pharmacy claims from May 2019-June 2021.

“For all patients, there was a substantial and significant flattening of the medication growth rate after the pandemic onset,” said Sumedha Gupta, an associate professor of economics at IUPUI and an adjunct professor in the O’Neill School, and the lead author of the study. “However, racial and ethnic minority patients experienced a significant and immediate actual decline in the level of prescriptions, which was not observed for white patients.”

Although the reasons for the disparity are currently undetermined, the study found that no immediate decreases in buprenorphine prescription fills among Medicaid patients, but there were wider disparities between racial and ethnic groups using private insurance or enrolled in Medicare.

“The finding implies that Medicaid programs may have provided a greater safety net to alleviate pandemic-related losses of income and health insurance coverage compared with other payer types,” said Kosali Simon, Distinguished Professor and Herman B Wells Endowed Professor in the O'Neill School at IU Bloomington and a senior author of the study. “Deaths from opioid use has been a silent killer during the pandemic. There was a large increase in opioid deaths in 2020 that didn’t get a lot of attention because the spotlight was on COVID. There was a huge number of deaths in Indiana alone as well as nationally. We need to look at what was happening outside of COVID illness, in opioid overdoses, which was among the highest public health priority pre-pandemic.”

The next steps in the research will be to take a closer look at all the factors involved in the decline in medication access and worsening of the racial and ethnic disparities that already existed.

“Our study contributes to a rapidly evolving policy landscape where there may be further opportunities to promote treatment access and health equity via policies such as telehealth, removing financial and insurance barriers, and providing necessary training to clinicians in primary care settings”, said Thuy Nguyen, Research Assistant Professor at the University of Michigan and first author of the study. “Further research should assess implications of these policies in addressing entrenched racial and ethnic disparities in adequate care for the estimated 2.7 million patients with opioid use disorder.”

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Ken Bikoff, Faculty Liaison and Public Relations Officer
Paul H. O’Neill School of Public and Environmental Affairs | Indiana University
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About the O’Neill School of Public and Environmental Affairs

The O’Neill School is a world leader in public and environmental affairs and is the largest school of public administration and public policy in the United States. In the 2023 "Best Graduate Public Affairs Programs" by U.S. News & World Report, the O'Neill School is the top-ranked program in the country. Five of its specialty programs are ranked in the top-five listings, including top-ranked concentrations in environmental policy and management; nonprofit management; and public finance.