Medicaid cuts may worsen opioid care gap

Introduction to the Crisis

Pharmacies in Black and Latino neighborhoods are less likely to dispense buprenorphine — one of the main treatments for opioid use disorder — even though people of color are more likely to die from opioid overdoses. The drug helps reduce cravings for opioids and the likelihood of a fatal overdose. While the nation as a whole has seen decreases in opioid overdose deaths in recent years, overdose deaths among Black, Latino and Indigenous people have continued to increase.

The Impact of Medicaid Cuts

Many medical and health policy experts fear the broad domestic policy law President Donald Trump signed in July will worsen the problem by increasing the number of people without health insurance. As a result of the law, the number of people without coverage will increase by about 10 million by 2034, according to the Congressional Budget Office. About 7.5 million of the people who will lose coverage under the new law are covered by Medicaid. Shortly before Trump signed the bill into law, researchers from the University of Pennsylvania and Boston University estimated that roughly 156,000 Medicaid recipients will lose access to medications for opioid addiction because of the cuts, resulting in approximately 1,000 more overdose deaths annually.

Barriers to Treatment

Because Black and Hispanic people are overrepresented on the rolls, the Medicaid cuts will have a disproportionate effect on communities that already face higher barriers to getting medications to treat addiction. From 2017 to 2023, the percentage of U.S. retail pharmacies regularly dispensing buprenorphine increased from 33% to 39%, according to a study published last week in Health Affairs. But researchers found the drug was much less likely to be available in pharmacies in mostly Black (18% of pharmacies) and Hispanic neighborhoods (17%), compared with mostly white ones (46%).

Pharmacy Deserts

Dr. Rebecca Trotzky-Sirr, a family physician who specializes in addiction medicine, said many communities of color are “pharmacy deserts.” Even the pharmacies that do exist in those neighborhoods tend to “have additional barriers to obtain buprenorphine and other controlled substances out of a concern for historic overuse of some treatments,” said Trotzky-Sirr, who wasn’t involved in the study. In addition to its federal classification as a controlled substance, buprenorphine is also subject to state regulations to prevent illegal use. Pharmacies that carry it know that wholesalers and distributors audit their orders, which dissuades some from stocking or dispensing it.

Disparities in Access

Dima Qato, associate professor of clinical pharmacy at the University of Southern California and an author of the Health Affairs study, said that without changes in policy, Black and Hispanic people will continue to have an especially hard time getting buprenorphine. “If you don’t address these dispensing regulations, or regulate buprenorphine from the aspect of pharmacy regulations, people are still going to encounter barriers accessing it,” she said. In neighborhoods where at least a fifth of the population is on Medicaid, just 35% of pharmacies dispensed buprenorphine, Qato and her team found. But in neighborhoods with fewer residents on Medicaid, about 42% of pharmacies carried the drug.

The Role of Medicaid

Medicaid covers nearly half— 47% — of nonelderly adults who suffer from opioid use disorder. In states that expanded Medicaid under the Affordable Care Act, another recent study found an increase in people getting prescriptions for buprenorphine. “Medicaid is the backbone of care for people struggling with opioid use disorder,” said Cherlette McCullough, a Florida-based mental health therapist. “We’re going to see people in relapse. We’re going to see more overdoses. We’re going to see more people in the ER.”

Need for Urgency

Qato and her colleagues say states and local governments should mandate that pharmacies carry a minimum stock of buprenorphine and dispense it to anyone coming in with a legitimate prescription. As examples, they point to a Philadelphia ordinance mandating that pharmacies carry the opioid overdose-reversal drug naloxone and similar emergency contraception requirements in Massachusetts. “We need to create expectations. We need to encourage our pharmacies to carry this to make it accessible, same day, and there needs to be urgency,” said Arianna Campbell, a physician assistant and co-founder of the Bridge Center, a California-based organization that aims to help increase addiction treatment in emergency rooms.

Patient Navigation

The Bridge Center has been expanding its patient navigator program across the state, and helping other states start their own. The program helps patients identify pharmacies where they can fill their prescription fastest. “There’s a medication that can help you, but at every turn it’s really hard to get it,” she said, calling the disparities in access to medication treatment “unacceptable.”

Conclusion

The disparity in access to buprenorphine in Black and Latino neighborhoods is a significant concern, and the looming Medicaid cuts will only exacerbate the issue. It is essential for policymakers to address these disparities and ensure that all individuals, regardless of their neighborhood or income level, have access to this life-saving medication. By mandating that pharmacies carry a minimum stock of buprenorphine and dispense it to anyone with a legitimate prescription, states and local governments can help reduce the barriers to treatment and prevent more overdose deaths.

FAQs

1. What is buprenorphine, and how does it help with opioid addiction?
   Buprenorphine is a medication that helps reduce cravings for opioids and the likelihood of a fatal overdose. It is one of the main treatments for opioid use disorder.
2. Why are pharmacies in Black and Latino neighborhoods less likely to dispense buprenorphine?
   Pharmacies in these neighborhoods tend to have additional barriers to obtaining buprenorphine, such as concerns about historic overuse of some treatments and state regulations to prevent illegal use.
3. How will the Medicaid cuts affect access to buprenorphine?
   The Medicaid cuts will have a disproportionate effect on communities that already face higher barriers to getting medications to treat addiction. Roughly 156,000 Medicaid recipients will lose access to medications for opioid addiction because of the cuts, resulting in approximately 1,000 more overdose deaths annually.
4. What can be done to address the disparities in access to buprenorphine?
   States and local governments can mandate that pharmacies carry a minimum stock of buprenorphine and dispense it to anyone with a legitimate prescription. They can also implement patient navigator programs to help patients identify pharmacies where they can fill their prescription fastest.
5. Why is it essential to address the disparities in access to buprenorphine?
   Addressing the disparities in access to buprenorphine is crucial to reducing the barriers to treatment and preventing more overdose deaths. It is also essential to ensure that all individuals, regardless of their neighborhood or income level, have access to this life-saving medication.
   

   By Nada Hassanein, Stateline.org