Why Aren't Doctors Prescribing Suboxone To More Black Patients?

By Maggie Ethridge 05/21/19

The total number of buprenorphine-related visits has surged but the number of black Americans receiving the medication has not increased.

Image: 
Black patient at the doctor

The racial disparity in the prescribing of opioid treatment drugs like Suboxone is highlighted in a new study out of the University of Michigan.

The study, published in JAMA, looked at two national surveys of prescriptions as reported by physicians between the years 2012 and 2015.

While the total number of buprenorphine-related medical visits drastically increased to 13.4 million during this time span, researchers noted that the number of buprenorphine prescriptions did not increase among African-Americans, or any other minorities.

Buprenorphine, most commonly known by the brand name Suboxone, is a medication that dramatically reduces opioid cravings and blocks the effects of opioids. 

"White Americans have 35 times as many buprenorphine-related visits than black Americans," Dr. Pooja Lagisetty, an assistant professor of medicine at the University of Michigan Medical School and the study's corresponding author, told NPR.

Although white Americans have been the face of the opioid epidemic, during the time period studied, the number of overdose deaths among black Americans was rising faster than their white counterparts.

In addition, there is a shortage of clinicians and clinics prescribing buprenorphine, Dr. Andrew Kolodny, co-director of Opioid Policy Research at Brandeis University, told NPR.

Currently, physicians must take on eight hours of training to become certified to prescribe buprenorphine. And even if they do receive authorization to prescribe it, they are then faced with a cap that only allows them to prescribe it to 30 patients in the first year and up to 100 patients afterwards. 

A bill in New York that would end the extra training required for physicians and nurses to dispense Suboxone, and the caps, has gained tremendous support. The special training for both doctors and nurses has meant that there are not enough providers who offer the lifesaving drug.

According to STAT News, only 5% of doctors have completed the training required to prescribe buprenorphine.

In France, where additional restrictions on prescribing opioid addiction treatment drugs were removed in 1995, there was an 80% decrease in opioid overdoses in the subsequent years.

Michael Botticelli, director of the Grayken Center for Addiction at Boston Medical Center and the former director of the Office of National Drug Control Policy, has questions about specific points of interest in the disparity between white and black patients receiving Suboxone.

Botticelli questions if Medicaid reimbursement rates are too low to attract doctors to work with low-income patients, or if there is a scarcity of inner-city doctors prescribing buprenorphine, or if African-Americans are not seeking the treatment for an unknown reason. 

White patients typically paid cash (40%) or used private insurance (35%) to fund their buprenorphine treatment. A mere 25% used Medicaid and Medicare to pay for their visits.

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Maggie May Ethridge is the author of Atmospheric Disturbances: Scenes From a Marriage (Shebooks, 2014) and the recently completed novel, Agitate My Heart. She is a freelance writer published in Rolling Stone, VOX, Washington Post, The Guardian and many others. Find her at her blog Flux Capacitor or on LinkedIn or Twitter.

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