In recent years, substance abuse has been on the rise. The pandemic has only exacerbated the issue, leading to skyrocketing rates of overdoses.
While overdose deaths have increased across every demographic group, Black men have experienced the biggest increase.
Increased use of substances like opioids led to a record of over 100,000 overdose deaths during a 12-month period ending April 2021—marking an increase of 28.5% from the same period the year before. The rate of Black men dying from overdoses has tripled since 2015.
States and community organizations are trying to tackle the issue through policy changes and grassroots efforts.
How Can Changing Policies Help?
In December 2021, New York passed legislation removing barriers to opioid use disorder treatment for New Yorkers covered by Medicaid, which is a government program providing health insurance assistance to people with low income or disabilities.
About 32% of Medicaid recipients in New York City alone are Black. New York is the latest of 22 states and Washington, D.C., to enact laws limiting public and/or private insurers from imposing prior authorization requirements on a substance abuse disorder (SUD) service or medication.
What Is Prior Authorization?
Prior authorization is a requirement that your healthcare provider or hospital obtains approval from your health insurance company before prescribing a specific medication for you or performing a particular medical procedure.
New York’s latest SUD legislation means that Medicaid-managed care plans need to cover all SUD medications without prior authorization.
Previously, these prior authorizations meant that healthcare providers were required to obtain approval from insurance companies before prescribing most medications for treating opioid addiction to people with Medicaid. This process could delay life-saving treatment by days.
There are three Food and Drug Administration (FDA) approved medications for treating opioid dependence: methadone, buprenorphine, and naltrexone.1
“Coverage for these different medications varies by insurance company. For example, not all insurance companies cover methadone treatment in an opioid treatment program, and copays for buprenorphine and naltrexone can vary widely if covered,” Kristine Torres-Lockhart, MD, assistant professor of medicine at Albert Einstein College of Medicine and director of addiction consult service at Weiler Hospital in the Bronx, told Verywell. “Additionally, some companies can require prior authorizations before approving to cover some of these medications.”
How Did COVID Change Addiction Treatment?
Torres-Lockhart emphasized that removing barriers to treatment does make a difference.
Since 2010, many states have even worked to expand access to Medicaid, which could help get people more access to SUD treatment. A provision in the Affordable Care Act calls for the expansion of Medicaid eligibility in order to cover more low-income Americans. This expansion extends Medicaid eligibility to adults up to age 64 with incomes up to 138% of the federal poverty level. Before this act, Medicaid was not typically available to non-disabled adults under age 65 unless they had minor children.
Thirty-eight states and Washington, D.C., have adopted Medicaid expansion. In 2021, Missouri and Oklahoma joined that list.
Approximately 34% of Medicaid enrollees are African Americans. However, one study in 2014 found that African Americans with substance use disorders who met new federal eligibility criteria for Medicaid were less likely than those of other racial and ethnic groups to live in states that expanded Medicaid.2
While expanding Medicaid allows for greater access to SUD medication and treatment, experts say more needs to be done.
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Community-Based Harm Reduction Efforts
Over the past two years, organizations and cities have also taken other approaches to take on SUD.
Organizations have begun encouraging people to carry naloxone (Narcan)—the opioid overdose reversal drug—to help others in their community. Some even offer training on how to administer it if you see someone in need. And in most states, you can get the drug at a local pharmacy without a prescription.3
Three months ago, New York City became the first U.S. city to officially open supervised injection sites in an attempt to curb overdoses, the first of its kind in the U.S. At these sites, people can use their own injectable drugs and opioids in a clean environment with access to safety resources. These sites are intended to curb the spread of disease through needle-sharing, prevent overdoses, and connect people to treatment.
The first two sites in NYC have reversed over 100 overdoses to date.
One recent study published in the Journal of Substance Abuse Treatment showed that hospitals in communities with high percentages of Black or Hispanic residents are less likely to offer opioid use programs.4 These kinds of community-based programs can step in to help when traditional institutions don’t.
Accessing Medications
Access to medication is one of the many hurdles Black patients face in getting effective treatment for opioid use disorder.
Historically, access to opioid treatment medications has been segregated. Methadone is more likely to be found in Black and minority communities and buprenorphine is more accessible in White communities. One 2016 study showed that counties with highly segregated African American and Hispanic/Latinx communities had more facilities to provide methadone per capita, while counties with highly segregated White communities had more facilities to provide buprenorphine per capita.5
Methadone treatment, while highly effective, is very regulated, requiring daily visits to the clinic to obtain the medication. When new to treatment, this can be very burdensome for patients and limit their ability to participate in care.
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On the other hand, any provider with a specific waiver can prescribe buprenorphine to any community pharmacy like most other medications. This example of structural racism limits the options for effective treatments for Black and minority communities.
“By increasing access to both methadone and buprenorphine, we can decrease the harms associated opioid use disorder in all communities as we know these medications save lives, decrease overdoses, improve quality of life, decrease non-prescribed opioid use, decrease withdrawal, and improve maternal/fetal outcomes, amongst many other benefits,” Torres-Lockhart said.