Living with opioid use disorder can be debilitating. For Black folks and people of color, accessing treatment can be even more challenging. One of those treatments is buprenorphine, a medication used to help people quit or reduce their use of opiates.
Opioid overdose deaths among Black Americans aged 15-24 increased by 86% between 2019-2020 — the most recent year data is available for — according to the Centers for Disease Control and Prevention. With Black Americans experiencing the highest increase in opioid overdose deaths, medications like buprenorphine are critical to prevent death.
But, because of stigma, price, and required monitoring, getting a filled prescription for this drug has become increasingly more difficult.
Buprenorphine is not a new medication. It was approved for clinical use in 2002 by the Food and Drug Administration. The medication helps diminish the effects of physical dependency — like withdrawal symptoms and cravings. Due to buprenorphine being an opioid, there is a stigma attached to replacing one drug with another.
One of the main medications used to treat opioid use disorders is Suboxone, the brand name of a combination of buprenorphine and naloxone. Some people think you can overdose on Suboxone just as easily as other opioids.
But, according to Harvard Medical School, that’s not true. Suboxone acts as a partial opiate receptor agonist, meaning there is a limit to how much the opioid receptors can be activated by the medication.
Michelle Sproule, a licensed professional counselor and chief clinical officer of Scottsdale Recovery Center, an Arizona drug, alcohol, and addiction rehab says “there’s so many benefits to these medications.” It reduces the rates of overdose deaths, overdoses, and overall dependence on opioids.
Word In Black reported last summer that overall drug overdose deaths increased by 30% in the U.S. from 2019 to 2020. But the CDC found that the death rate for those in the Black community increased by 44% in the same two years. Sproule says medications like buprenorphine can “save their life,” but a few factors have made it difficult for individuals to access them.
“Access to quality treatment, access to quality providers can be dictated so much by financial resources, their insurance resources, their local community,” Sproule says.
In 2020, the average cost of buprenorphine without insurance was $246.11 and drops to $96.74 with insurance. Meaning, for one prescription, people with opioid use disorders would pay about $8 a day without insurance. For those with insurance, depending on the type of provider, folks would pay $4 a day for the medication.
Depending on the severity of the disorder, someone may be prescribed Suboxone for about six months or longer. Medicare is one of the only insurance plans that fully covers the cost of Suboxone. Other health insurance plans — like Aetna, Humana, and Kaiser — may offer full or partial coverage depending on the provider, location, and patient.
Suboxone is typically paired with other forms of therapy like support groups, talk therapy, and recovery coaching. But only 10-20% of people with opioid use disorders are getting a combination of recovery treatments.
When someone with opioid use disorder starts the treatment with buprenorphine, Sproule says it does require more monitoring to make sure the dose is effective and safe.
“From my perspective of being a clinician that has worked in treatment … being able to understand what the differences are in the inequity of care, especially for people of color and getting access to appropriate health insurance coverage and treatments, it can be very challenging for individuals,” she says.
On top of that, depending on the prescription and monitoring needed, folks receiving treatment may need to meet with a provider on a weekly basis. Sproule says this can pose challenges because individuals need to take time off work, find childcare, and have transportation.
“I can’t tell you how many times I see it where they’re with an employer and they have a substance use disorder and now have to go on leave or they lose their job and their insurance coverage,” she says.
African Americans Less Likely to Be in Treatment
For Dr. Karen Scott, it’s no surprise there is a significant racial and ethnic disparity between access to opioid use disorder treatment. Scott is the president of the Foundation for Opioid Response Efforts, a grantmaking foundation working to end the opioid crisis.
Methadone is another FDA-approved medication to treat opioid use disorder. It’s a long-acting opioid, meaning the drug lasts longer in your body to reduce opioid craving and withdrawal. Because it’s more potent than buprenorphine, an individual would have to receive this medication under the supervision of a practitioner. For some folks in the Black community, accessing and affording an in-patient treatment program for methadone is inconvenient.
“Buprenorphine is an easier medication to take, stay on, and is more accessible in theory,” Scott says. “But the data shows Black people with opioid use disorder are less likely to be on that medication. So that’s a significant gap that warrants a lot of attention.”
The rates of opioid-involved deaths were higher among Black folks in counties with no opioid treatment programs, the CDC study found. Overdose death rates suggest that despite the availability of treatment programs, like buprenorphine, communities of color continue to struggle with access.
Expanded Access, But More Pharmacies Refuse to Carry Buprenorphine
In a move that made access more difficult, The Drug Addiction Treatment Act of 2000 created what’s known as an X-waiver. The waiver legislation authorized outpatient use of buprenorphine, meaning providers were required to obtain this special license to prescribe this controlled substance.
The Drug Enforcement Administration and the Substance Abuse and Mental Health Administration eliminated the X-waiver in Dec. 2022.
With the elimination of this waiver, providers still need a standard DEA registration number, according to the DEA Diversion Control Division. But, now there are no longer limits to the number of patients with opioid use disorder a prescriber can treat with buprenorphine.
However, some pharmacies can still choose not to carry this medication.
In a June 2022 Drug and Alcohol Dependence study, researchers found that less than half of pharmacies in the 11 states surveyed had buprenorphine available. Chain pharmacies were more likely to have buprenorphine and naloxone available than independent pharmacies.
Some pharmacies may be hesitant to fill a prescription because they are unsure of DEA requirements or don’t want to deal with the regulations, Scott says.
“It’s hard not to think back to stigma and say how much of this is ‘I don’t want those patients in my store,’” she says. “But a lot of it has been put on if it’s a heavier regulatory burden ‘we’re not gonna deal with it.’ Some of the guideline and training work is to quit.”
Without proper training, life-saving medication like buprenorphine will continue to not be administered to communities that are hardest hit by the opioid crisis.
As a solution, FORE announced earlier this month that $2 million in grants to increase access to medications like buprenorphine would be given to four organizations: The University of Houston College of Pharmacy, Howard University, University of Kentucky College of Pharmacy, and the Emergency Medicine Foundation.
Each organization will receive a range of $240,000 to $740,000 over a two-year period to provide safe and effective care for patients with opioid use disorders.
“What we heard from our first grantees … was that patients were taking prescriptions to pharmacies that weren’t filling them,” Scott says. FORE’s goal is to provide “more training, and more guidelines for pharmacists.”