Factors Associated with Racial Inequity in Receipt of Medication for Opioid Use Disorder

Medications to treat opioid use disorder (MOUD)—methadone, buprenorphine, and naltrexone—have been shown to be effective, but in the US, Black individuals are less likely to receive this treatment than White individuals. The reasons for this disparity are not well understood. Researchers used data from the Allegheny County (Pennsylvania) Department of Human Services to investigate potential factors associated with this disparity, including criminal justice involvement, interaction with human services, and health-related mediators.

  • The sample included 6374 Allegheny County residents aged 18–64 years who were enrolled in Medical Assistance and were diagnosed with OUD between 2015 and 2017, with no recorded diagnosis of OUD in the prior 3 months.
  • Initiation of MOUD differed significantly between racial groups with 30% of Black enrollees initiating MOUD compared with 51% of White enrollees.
  • Five mediators were identified: having a non-OUD substance use disorder (SUD) diagnosis, months of housing support, days in jail, days in an emergency department, and use of intensive non-MOUD SUD treatment.
  • When taking into account the mediators, the disparity decreased from 21% to 14%, accounting for 23% of the gap.

Comments: This study suggests that improving access to MOUD in criminal justice settings, emergency departments, and intensive SUD treatment may address some of the racial disparity in receipt of MOUD in the US. However, much more will need to be done to further understand and close this gap.

Darius A. Rastegar, MD

Reference: Hollander MAG, Chang CH, Douaihy AB, et al. Racial inequity in medication treatment for opioid use disorder: exploring potential facilitators and barriers to use. Drug Alcohol Depend. 2021;227:108927.


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