Study shows people in impoverished neighborhoods have difficulty getting medication for drug addiction • Oregon Capital Chronicle

Patients battling addiction may have difficulty filling their opioid use disorder prescription at their local pharmacy if they live in a low-income neighborhood or minority community, according to a new nationwide study led by an Oregon State University researcher.

The study, also led by a John Hopkins University researcher, highlights inequities in the health care system that dispenses life-saving drugs amid a nationwide overdose epidemic. In Oregon, nearly 1,400 people died from opioid overdoses in 2023, up from 280 in 2019, according to data from the Oregon Health Authority.

Nationwide, more than 100,000 people have died from overdoses, three-quarters of which were opioid-related. The deaths disproportionately affect communities of color, including blacks and Hispanics. Their overdose death rate has nearly tripled in the past decade, compared with a 58% increase among whites, the studypublished in Drug and Alcohol and Dependence Reports.

“Although there have been notable policy changes over the past decade that have improved access to medications for opioid use disorder and made progress in combating racial discrimination, these efforts have not addressed whether patients are actually getting their prescriptions filled,” said study co-author Dan Hartung, a researcher and professor who teaches at the OSU College of Pharmacy and Oregon Health & Science University.

Fentanyl is a synthetic opioid that can be legally prescribed to relieve severe pain. But fentanyl, which is highly addictive and deadly, is also manufactured illegally and sold on the street, often after being mixed with other drugs to make them even more addictive.

The prescription drug buprenorphine offers people a chance at recovery. The drug helps relieve pain and cravings during opioid withdrawal and reduces the risk of death from overdose.

But to receive this care, people need treatment – ​​including a prescription and a pharmacy to dispense it.

“It's a life-saving drug,” Hartung said. “It's difficult enough to find doctors who will prescribe these therapies. But then you have to find a pharmacy and make sure the pharmacy dispenses the drug. So there are several obstacles for patients with addictions.”

The researchers examined data from telephone calls to 858 pharmacies in 473 counties across the United States. In each case, the caller contacted a pharmacy and asked about filling a buprenorphine prescription.

Overall, around 20 percent of pharmacies are unable to provide the medication, Hartung said. However, pharmacies in poorer neighborhoods are twice as likely to restrict access as those in privileged areas, he said.

Oregon pharmacies played a minor role in the study's findings. Only 6% of the pharmacies surveyed – about 54 – were in the West, including Oregon. But the findings still underscore the need for access to the drugs in Oregon, especially as small pharmacies in rural areas close, Hartung said.

There are several possible reasons why pharmacies may be unable to dispense buprenorphine. Distribution of buprenorphine is regulated by the Drug Enforcement Agency, and pharmacists may be cautious about how much of the drug they buy from wholesalers so as not to trigger an investigation. Pharmacies, especially independent ones with fewer resources, may have less inventory due to the cost.

The history of drug treatment for opioid addiction has racist roots. In the 1960s, methadone – also a treatment drug – was used in urban areas to combat crime, the study says. During this time of increasing civil unrest, these programs were often introduced in neighborhoods with people of color, the study says.

Buprenorphine, however, was developed during the opioid overdose epidemic that accompanied prescription drugs. The Food and Drug Administration approved its use to treat opioid addiction in 2002. This measure allowed doctors to write prescriptions for buprenorphine in offices and it reached white, middle-class patients, the study found. The result: White patients are about four times more likely to receive buprenorphine than black patients.

“These barriers to drug dispensing in pharmacies could exacerbate inequities in access to treatment,” said Kyle Moon, a researcher at John Hopkins University, in a statement. “And it shows that future policies to improve health equity must target dispensing capacity to expand the capacity that already exists to make it easier for providers to prescribe buprenorphine.”

In Oregon, lawmakers passed Bill 4002that allows counties to set up programs to help addicted people get help instead of facing criminal charges and jail time for drug possession. The bill also includes changes to make it easier for people to access medication to treat their addiction.

For example, insurers will no longer be allowed to ask for time to review a prescription's coverage before approving treatment. This process is called prior authorization and can delay the dispensing of medications. The bill also gives pharmacists more flexibility to replenish supplies early.