Medicaid Cuts Limit Opioid Care, Widen Racial Gaps

Author

Susan Bertram

About the Author

Medical Reviewer

Eric Owens

About the Editor

New research shows Medicaid cuts limit opioid treatment access and worsen racial disparities, leaving Black and Latino communities at higher risk.

Despite facing higher rates of fatal opioid overdoses, people of color often struggle to access addiction treatment medications like buprenorphine. They are less likely to be dispensed in Black and Latino Neighborhoods.

Overdose Increase

Buprenorphine helps reduce a person’s craving for opioids, which means reducing the odds of a fatal overdose. In recent years the US has seen a decrease in opioid overdose deaths. However, among Latino, Black and Indigenous people, overdose deaths have increased.

New Domestic Policy Law

President Donald Trump’s domestic policy law has medical and health policy experts concerned. The fear is that the law will increase the number of people without health insurance and worsen the problem.

According to the Congressional Budget Office, the law will result in about 10 million more people without health insurance coverage by 2034. About 7.5 million people now covered by Medicaid will lose their coverage.

Researchers from Boston University and the University of Pennsylvania estimated that the nation would see approximately 1,000 more annual overdose deaths. This is due to approximately 156,000 Medicaid recipients losing access to opioid addiction medications due to cuts resulting from the new law.

Health Affairs Study

A recent study published in Health Affairs noted that between 2017 and 2023, the percentage of retail pharmacies in the US dispensing buprenorphine regularly rose from 33 to 39 percent. Researchers found disparities in the availability of the drug.

It was found to be less available in pharmacies in Hispanic (17%) and Black (18%) neighborhoods when compared to pharmacies in mostly white neighborhoods (46%). Some states revealed an even greater disparity.

Only about 9% of pharmacies in Black neighborhoods in California provided buprenorphine, though 50% of California’s white neighborhoods dispensed the drug. Buprenorphine was the least available in Latino and Black neighborhoods in almost every state, according to researchers.

Treatment Barriers

A family physician specializing in addiction medicine, Dr. Rebecca Trotzky-Sirr noted that too often, communities of color are pharmacy deserts. The doctor also noted that due to historic overuse of various treatments, pharmacies in those neighborhoods have additional barriers when it comes to obtaining controlled substances such as buprenorphine.

To prevent illegal use, buprenorphine is subject to state regulations. Associate professor of clinical pharmacy at the University of Southern California, Dima Qato, noted that Hispanic and Black people may find it especially difficult getting buprenorphine without policy changes enacted.

Qato and her team discovered that in neighborhoods where a minimum of a fifth of the population uses Medicaid, only 35 percent of the pharmacies dispensed buprenorphine. About 42% of pharmacies carried the drug in neighborhoods where fewer residents used Medicaid.

A Florida based mental health therapist, Cherlette McCullough, expressed that, “Medicaid is the backbone of care for people struggling with opioid use disorder.”

Urgent Matter

Qato and her colleagues believe local governments and states should require pharmacies to carry a minimum amount of buprenorphine and provide it to those with legitimate prescriptions. Experts point to existing ordinances, such as that in Philadelphia that mandates pharmacies to carry naloxone (an opioid reversal drug) and a Massachusetts requirement for stocking emergency contraception.

Arianna Campbell, co-founder of the Bridge Center (a California-based organization working to increase ER addiction treatment) and a physician assistant, explains that “We need to encourage our pharmacies to carry this to make it accessible, same day…”

The Bridge Center’s patient navigator program helps patients find pharmacies where they can get their prescriptions filled the quickest. They’ve been expanding the program across California and assisting other states in starting their own programs.

Fear of Regulatory Scrutiny

It was about two decades ago that buprenorphine was put on the controlled substances list, according to Bloomberg Professor of American Health in Addiction and Overdose at Johns Hopkins University, Brendan Saloner.

There is no pressure on pharmacies to ensure that clients receive the treatment they need, Saloner said, but there is fear from pharmacies of drawing regulatory scrutiny. Adding to the problem is the authorization process of Medicaid’s managed care plans.

Saloner expressed that Black and Latino communities have higher rates of Medicaid enrollment and that Medicaid prior authorization techniques are a hassle to pharmacies. He argued that may also discourage pharmacies from stocking buprenorphine.

According to the study, buprenorphine is much more available in Vermont, Utah, Maine, New Hampshire, Oregon and Rhode Island, where over 70% of pharmacies stock the drug. In states like Oregon that have the least restrictive dispensing regulations for buprenorphine, they have the highest availability.

If you’re struggling with substance use disorders, Rehabs.org lists free and low cost treatment centers that accept Medicaid and other insurance programs.

Call 800-914-7089 (Sponsored) today for immediate support.