Differences in the delivery of medications for opioid use disorder during hospitalization by racial categories: A retrospective cohort analysis

Abstract

Background: As the drug-related overdose crisis and COVID-19 pandemic continue, communities need increased access to medications for opioid use disorder (MOUD) (i.e., buprenorphine and methadone). Disparities in the type of MOUD prescribed or administered by racial and ethnic categories are well described in the outpatient clinical environment. It is unknown, however, if these disparities persist when MOUD is provided in acute care hospitals. Methods: This study assessed differences in the delivery of buprenorphine versus methadone during acute medical or surgical hospitalizations for veterans with opioid use disorder (OUD) by racial categories (Black Non-Hispanic or Latino vs. White Non-Hispanic or Latino). Data were obtained retrospectively from the Veterans Health Administration (VHA) for federal fiscal year 2017. We built logistic regression models, adjusted for individual and hospital-related covariates, and calculated the predicted probabilities of MOUD delivery by racial categories. Results: The study cohort (n = 1,313 unique patients; N = 107 VHA hospitals) had a mean age of 57 (range 23 to 87 years), was predominantly male (96%), and composed entirely of Black (29%) or White (71%) patients. White patients were 11% more likely than Black patients to receive buprenorphine than methadone during hospitalization (p = 0.010; 95% CI: 2.7%, 20.0%). Among patients on MOUD prior to hospitalization, White patients were 21% more likely than Black patients to receive buprenorphine (p = 0.000; 95% CI: 9.8%, 31.5%). Among patients newly initiated on MOUD during hospitalization, there were no differences by racial categories. Conclusion: We observed disparities in the delivery of buprenorphine versus methadone during hospitalization by racial categories. The observed differences in hospital-based MOUD delivery may be influenced by MOUD received prior to hospitalization within the racialized outpatient addiction treatment system. The VHA and health systems more broadly must address all aspects of racism that contribute to inequitable MOUD access throughout all clinical contexts.

Keywords:

• Racism
• methadone
• buprenorphine
• opiate substitution treatment
• hospitals
• opioid-related disorders
• healthcare disparities

Disclosure statement

None of the authors report a conflict of interest. The views expressed in this article are those of the authors’ and do not necessarily represent the views of the U.S. Department of Veterans Affairs, the U.S. Government, or any of our funding agencies.

Additional information

Funding

This work was supported by the National Institute on Drug Abuse [F30 DA044700; F30 DA052972; UG1DA015815], the Greenlick Family Scholarship, the OHSU MD/PhD Program, National Center for Advancing Translational Sciences [TL1TR002371], U.S. Department of Veterans Affairs Health Services Research & Development [I01HX002518], and the University of Pittsburgh Department Psychiatry Emerging Star Award. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.