Social discourse among policy makers, the news media, and the general public has portrayed the opioid epidemic in the US as primarily affecting White people. Rates of opioid misuse and death are, in fact, higher among non-Hispanic White people (hereafter “White people”) relative to people of other races/ethnicities in most states. But the recent focus on White populations ignores the havoc that the opioid epidemic has wreaked on people of color, including Black, Hispanic, and Native American populations. Nationally, between 2013 and 2017, deaths from synthetic opioids other than methadone increased eighteenfold among Black people and twelvefold among Hispanic people compared with ninefold among White people. In several states Black people have a higher rate of opioid-related death than White people, and the overdose rate among people of color is rising rapidly.

Opioid use disorder (OUD) can be successfully treated with medications for OUD, which are considered the gold standard of care. Among these medications, buprenorphine and methadone are the most effective at decreasing risk for overdose death. Because no validated algorithm exists for matching patients to specific medications for OUD, all such medications should be available to all people with OUD.

Despite their effectiveness, medications for OUD are extremely underused in the US for various reasons. Similar to other substance use disorders (SUDs), OUD is stigmatized as a moral or criminal condition rather than a health condition, thus reducing help-seeking behavior. Also, medications for OUD are often misunderstood as “just another drug,” with many people viewing them as substances of misuse rather than effective treatment for OUD. Too few providers of medication for OUD exist, with only 16 percent of specialty SUD treatment programs in the US offering any medication for OUD. There are insurance-related administrative barriers, such as prior authorization requirements, and cost barriers, including copayments for people with insurance and high out-of-pocket payments for people without insurance. Furthermore, many providers of medications for OUD do not accept Medicaid, thus creating an access barrier for people with Medicaid coverage.

A study of medical records of 1.4 million primary care patients found that only 21 percent of patients with OUD received buprenorphine, and fewer than 12 percent of such patients across five primary care systems received methadone treatment. Unlike methadone treatment for OUD, buprenorphine is available in outpatient physician offices, so long as the clinician has a federal waiver to prescribe it. In contrast, methadone is only available in heavily regulated and stigmatized opioid treatment programs. Retention in treatment using medication for OUD is problematic, with more than one-quarter of patients stopping buprenorphine treatment in the first month, more than half of patients stopping buprenorphine within one year, and almost 40 percent of patients stopping methadone within one year, even though longer retention leads to better health outcomes.

To assist with developing treatment quality measures and provider accreditation criteria, addiction researchers have conceptualized OUD treatment as a cascade of multiple stages, including engagement, initiation, retention, and remission. In this article I focus on initiation and retention of treatment with medication for OUD, which are the two OUD treatment milestones most directly related to lowering mortality. I explain why people of color are less likely than White people to access medications for OUD, discuss why people of color receiving these medications tend to receive the more stigmatized treatment option, and explore factors that may lead to lower retention rates among people of color. Finally, I provide policy recommendations to address each of these issues.

Barriers To Treatment: A History Of Segregation And Discrimination

Even though the average national rate of providers of medication for OUD per county has increased since 2002, expansion of these providers into communities of color has been minimal. Multiple studies have found that people of color are less likely than White people to access medication for OUD. For example, a national study of more than 13 million outpatient SUD-related visits with buprenorphine prescribing found that 12.7 million of the visits were for White patients versus 363,000 for patients of other races/ethnicities. Reasons for these disparities include shortages of providers (particularly those accepting Medicaid) in communities of color and interpersonal discrimination.

SUD treatment facilities with high proportions of people of color are less likely than those with predominantly White patients to offer medication for OUD, possibly reflecting the lack of waivered buprenorphine providers in the surrounding communities or less willingness among administrators to offer medication for OUD when most patients are people of color. More research is needed to understand administrative decision making about the availability of medication for OUD in these facilities. People of color are twice as likely to have Medicaid as White people, yet SUD treatment facilities that accept Medicaid are less common in counties with high proportions of people of color. People worried about discrimination, whether because of their race/ethnicity or drug use, are less likely to seek treatment or to have a regular treatment provider. Because people of color are more likely than White people to be prosecuted for drug-related crimes, they are more likely than White people to avoid SUD treatment out of fear that treatment providers will report their drug use to authorities.

Methadone Treatment Among People Of Color: A Trifecta Of Stigmas

Buprenorphine and methadone are distributed quite differently across racial/ethnic groups, with White populations more likely to receive buprenorphine and people of color more likely to receive methadone. This trend is problematic for several reasons. First, methadone is the most stigmatized medication for OUD. It is a full opioid agonist and thus is more lethal if misused. This aspect of methadone reinforces the misconception of medications for OUD as “just another drug.” Second, methadone has historically been identified as a tool to control crime. The first methadone treatment regulations, released in 1972, reflected the Nixon administration’s perception of methadone treatment as a crime prevention tool, particularly in Washington, D.C., and as a response to fears of Vietnam veterans returning home with heroin use disorder. President Richard Nixon had campaigned on a law-and-order platform in response to nationwide civil unrest, which conservatives had labeled “race riots.” Once in the White House, he shifted his law-and-order priorities to focus increasingly on the perceived rise in heroin-related crimes in Washington, D.C., which were blamed on Black people. It is unclear from the available historical data whether a rise in heroin-related crimes actually had occurred or whether law enforcement had simply increased the attention paid to a preexisting problem. President Nixon was impressed with a pilot program of methadone treatment in the Washington, D.C., correctional system, which program leaders claimed had significantly decreased heroin-related crime in the city. Eventually, this pilot program served as a model for a nationwide system of opioid treatment programs—one that was highly regulated, had punitive elements (for example, limited availability of medication to take home, required daily medication dosing supervised by clinic staff, and scheduled urine drug screenings), and was primarily based in impoverished urban centers densely populated by people of color. As historian Mical Raz explains, the regulations framed methadone treatment not as part of a physician-patient therapeutic relationship but as part of a tightly controlled system with extensive surveillance that implied distrust of patients. Patients receiving methadone, who were disproportionately Black, were required to receive treatment in a structure more similar to the criminal justice system than to community-based treatment. Thus, these regulations reinforced the perception that methadone was a treatment for criminals. Since 2001 federal law has required accreditation of opioid treatment programs; to obtain accreditation, these programs must meet specified standards of patient satisfaction, service integration, and individualization. Nevertheless, federal regulations still include punitive elements such as requirements for daily supervised dosing, limits on the amount of medication that can be taken home, and frequent urine drug screenings. Given the history of opioid treatment program regulations, some Black communities have viewed methadone as a form of social control.

One study found that methadone treatment is independently and positively associated with racial discrimination in health care settings. Indeed, the political imagery of methadone treatment users is that of poor Black and Hispanic patients as opposed to the image of privately insured White patients receiving buprenorphine treatment. It is easier for politicians to justify the more stringent regulations for methadone treatment than for buprenorphine treatment, as methadone treatment regulations affect a more stigmatized population. Because of limited buprenorphine treatment access for people of color and the more stigmatized nature of methadone, people of color are caught in a web of intersecting stigmas: stigma of OUD, stigma of methadone, and stigma associated with their race/ethnicity.

Finally, the limitation on methadone treatment settings can create substantial life challenges. The daily, in-person dosing required in opioid treatment programs may interfere with employment or child care. As a result, people receiving methadone treatment have said they feel like it “controls” their lives. In contrast, buprenorphine has a safer pharmacological profile (for example, it is less lethal if misused and has a “ceiling effect,” whereby effects of increased doses eventually plateau), so buprenorphine can be prescribed in office-based practices, such as primary care settings, and obtained monthly from a community pharmacy. Therefore, buprenorphine treatment is more convenient, and patients can better control their schedules. Primary care settings can also provide a layer of confidentiality (that is, OUD is not an obvious appointment reason) that is not available to patients seen entering opioid treatment programs.

Buprenorphine treatment is largely unavailable to people of color—the very people who could most benefit from its lower stigma.

Buprenorphine treatment is largely unavailable to people of color—the very people who could most benefit from its lower stigma. Opioid treatment programs are more commonly located in predominantly Black or Hispanic neighborhoods, whereas buprenorphine providers are more commonly located in White neighborhoods. In a national study of community segregation and medication for OUD, each 1 percent decrease in the chance a White resident will meet a Black resident in a neighborhood was associated with eight more buprenorphine providers per 100,000 people. In contrast, each 1 percent decrease in the chance a Black resident will meet a White resident in a neighborhood was associated with 0.6 more opioid treatment programs per 100,000 people. Therefore, it is unsurprising that people of color are significantly less likely to start receiving buprenorphine compared with methadone. Also, people of color are more likely than White people to have Medicaid, but buprenorphine providers are typically physicians who do not accept Medicaid.

Regardless of the type of medication for OUD treatment that patients receive, initiation of treatment has little benefit without retention, which likewise evidences disparities by race/ethnicity.

Disparities In Treatment Retention Among People Of Color

Among all populations, retention in both methadone and buprenorphine treatment is very low. For each type of medication, people of color are even less likely to be retained than White people. In a recent systematic review of retention in treatment with medication for OUD, approximately half of the studies examining race/ethnicity found significantly lower retention among Black people than White people. For example, a multistate study of Medicaid claims found that people of color were 31 percent less likely to be retained beyond six months in buprenorphine treatment compared with White people.

Reasons for lower retention of people of color in treatment with medication for OUD are not well understood, but studies have found several factors that may play a role. The greater the community deterioration (for example, as measured by rates of home ownership, employment, and poverty), the lower the retention rate for treatment with medication for OUD. Deterioration is more common among communities of color than in predominantly White communities, potentially causing psychological distress. These factors, along with low availability of psychosocial support in communities of color, could decrease treatment adherence. People of color are also more likely than White people to experience unstable housing and unemployment, both of which are associated with lower retention in treatment with medication for OUD. Yet one study found that people of color are less likely than White people in SUD facilities to receive targeted support to facilitate access to stable housing and employment. People of color are also more likely to experience unreliable transportation, which is associated with early discontinuation of treatment with medication for OUD and is particularly important for daily opioid treatment program visits.

People of color are more likely to have multiple SUDs than are White people, yet they receive fewer individualized services targeting co-occurring conditions. Inadequate treatment of co-occurring SUDs reduces retention in treatment with medication for OUD, possibly because the use of other drugs interferes with forming recovery-oriented social networks and leads to involuntary discharges for violating treatment facility rules.

The higher the proportion of people of color among clients, the lower the dosages of methadone provided by opioid treatment programs, even when program directors are Black. Low dosages of methadone are associated with lower treatment retention than higher dosages, as they are typically insufficient to manage cravings and withdrawal symptoms. Furthermore, people of color experience racial/ethnic discrimination intersecting with the stigma of medication for OUD, potentially prompting treatment cessation. Unfortunately, health care practitioners may view poor retention as a negative reflection on their patients as a result of implicit biases that conceptualize people who use drugs and people of color as immoral or criminal, rather than as a result of structural disparities.

In summary, people of color are less likely to start and be retained in treatment with medication for OUD than are White people. When they do start medication for OUD, they are more likely to start methadone treatment, which is more burdensome and stigmatized. Several policy options could help address underlying factors contributing to these disparities.

Policy Recommendations

Expand Medicaid In All States

Medicaid expansion is a critical policy lever for increasing initiation of medication for OUD among low-income, uninsured populations.

As the primary insurer for people with OUD and as an entitlement program with guaranteed coverage to all who qualify, Medicaid should serve as the foundation for increasing access to medication for OUD. Medicaid expansion is a critical policy lever for increasing initiation of medication for OUD among low-income, uninsured populations. Evidence is strong that Medicaid expansion has increased access to SUD treatment and the prescribing of medication for OUD overall, although benefits may be greater for White people and Hispanic people than for Black people. Because Medicaid covers approximately half of people with OUD and people of color are twice as likely to have Medicaid as are White people, it is likely that Medicaid expansion in the twelve states that have yet to do so would help people of color access medication for OUD.

Provide Grants To Expand Buprenorphine Treatment

Buprenorphine treatment outcomes in federally qualified health centers mirror those in other health care settings. The proportion of people of color treated in these centers versus other settings has increased significantly in recent years. To increase access to buprenorphine for low-income people of color, the Health Resources and Services Administration should increase the level of grant funding for federally qualified health centers to implement buprenorphine treatment. One recent study found that federal grants for the purpose of increasing the capacity for treatment with medication for OUD in federally qualified health centers have resulted in increased use of medication for OUD in these settings. Grants could tie bonus payments to centers that achieve specified levels of performance on quality metrics (for example, retention beyond eighteen months).

Expand Access To Practitioners In Communities Of Color

To reduce racial/ethnic disparities in types of medications used for OUD, policy makers first must acknowledge that these medications are not “race neutral” and that people of color who use methadone experience stigma related both to their race/ethnicity and to medications for OUD, particularly methadone. Policies to promote equity in access to medications for OUD need to increase access to buprenorphine among communities of color. To this end, the Substance Abuse and Mental Health Services Administration (SAMHSA) should provide a one-time stipend for practitioners to complete buprenorphine treatment training and waiver application if the practitioner works in a community of color. In addition, SAMHSA should increase the level of funding for the national Providers Clinical Support System, which has increased the uptake of buprenorphine waivers by connecting experienced buprenorphine prescribers with inexperienced health care practitioners.

The federal government should also make recently enacted temporary telehealth flexibilities permanent because telehealth could allow buprenorphine providers to treat new patients of color even if those patients live in a different geographic area. During the COVID-19 pandemic, the federal Drug Enforcement Administration began permitting buprenorphine induction via telehealth, which could facilitate treatment of people of color by providers who do not live in the same geographic area. However, emerging evidence suggests that buprenorphine providers are more comfortable using telehealth to treat existing patients than new patients, possibly because of a lack of best-practice standards for telehealth buprenorphine induction or liability concerns. Telehealth best-practice guidance from national health organizations could facilitate the induction of people of color who live in different geographic areas from buprenorphine providers.

In addition, states should leverage all available financing options, including Medicaid and grant funding, to support services provided through collaboration between community health workers and waivered buprenorphine providers. Community health workers could serve as liaisons with communities of color that lack buprenorphine access. Ideally, these workers would be people of color who have experience with SUD to build understanding and trust between the treatment population and buprenorphine treatment providers.

Make Methadone Treatment More Flexible And Convenient

The Drug Enforcement Administration and SAMHSA should change regulations to allow methadone treatment for stable patients in office-based practices, a practice permitted in several other countries. This change would help avoid stigma associated with the punitive structure of methadone delivery in opioid treatment programs. SAMHSA should also make permanent the temporary COVID-19 pandemic–related opioid treatment program flexibilities that allow taking home two to four weeks of methadone at a time, as opposed to requiring supervised daily dosing in the clinic.

Cover Ancillary Services To Increase Retention In Treatment

Medicaid should cover medications for OUD without prior authorization and other burdensome administrative requirements; it also should include comprehensive ancillary services that help address co-occurring SUDs, unemployment, and unstable housing, which are major risk factors for discontinuation of treatment. Specifically, states should seek Medicaid Section 1115 waivers to cover housing and employment support services, as well as contingency management (which rewards patients for positive behaviors) to help treat co-occurring SUDs. Several states already have used waivers for expanding SUD services. Consistent with a person-centered harm reduction approach, Medicaid policy should not require patients seeking medication for OUD to engage in additional services, as such requirements could deter some patients from seeking help.

Conclusion

A multifaceted approach is needed to address racial and ethnic disparities in treatment and retention with medication for OUD.

Buprenorphine and methadone are the most effective treatments for OUD but have disproportionately low treatment initiation and retention levels among people of color. Furthermore, people of color who access medication for OUD are significantly more likely to use methadone than buprenorphine, even though buprenorphine is less stigmatized and has a less burdensome treatment regimen. A multifaceted approach is needed to address racial and ethnic disparities in treatment and retention with medication for OUD. The Biden administration’s stated commitment to advancing racial equity is an important first step toward pursuing policies to reduce disparities in treatment with medication for OUD.

Summary

Analysis reveals that while the opioid epidemic in the US is often framed as primarily affecting White individuals, significant disparities exist in opioid-related morbidity and mortality across racial and ethnic groups. National data demonstrates that deaths from synthetic opioids increased dramatically among Black and Hispanic populations between 2013 and 2017, exceeding the rate of increase observed among White individuals. Despite the efficacy of medication-assisted treatment (MAT) for opioid use disorder (OUD), significant underutilization persists, particularly among minority populations. This disparity arises from a confluence of factors encompassing stigma surrounding OUD and MAT, limited access to providers, particularly those accepting Medicaid, and systemic barriers to care.

Barriers to Treatment: A History of Segregation and Discrimination

The expansion of medication-assisted treatment (MAT) providers has not proportionally reached communities of color. Studies consistently demonstrate that racial/ethnic minorities have reduced access to MAT compared to White populations. This disparity is attributed to provider shortages, particularly in underserved communities, coupled with pervasive interpersonal discrimination. Treatment facilities serving a higher percentage of minority patients are less likely to offer MAT, potentially reflecting local provider deficiencies or institutional biases. The disproportionate reliance on Medicaid among minority populations exacerbates these disparities, as fewer MAT facilities accept Medicaid coverage in counties with larger minority populations. Fear of discrimination further discourages help-seeking behavior among individuals from minority communities, compounded by the risk of legal repercussions for drug-related offenses.

Methadone Treatment Among People of Color: A Trifecta of Stigmas

Significant racial/ethnic disparities exist in the distribution of buprenorphine and methadone for OUD treatment, with White individuals disproportionately receiving buprenorphine, while minorities are more likely to receive methadone. This disparity is concerning due to the heightened stigma associated with methadone, its higher potential for misuse and lethality, and its historical association with crime control. The origins of these disparities are rooted in the historical context of methadone treatment regulations, which were implemented partly in response to social unrest and fears of rising crime rates in predominantly Black urban areas. Consequently, these regulations created a treatment system resembling criminal justice oversight, reinforcing negative perceptions of methadone treatment as a measure of social control. This historical context, coupled with the current regulatory framework governing methadone distribution, perpetuates stigma and creates substantial life challenges for individuals undergoing this form of treatment. This confluence of stigma surrounding OUD, methadone, and race/ethnicity negatively impacts minority access to effective and less stigmatized treatment options.

Disparities in Treatment Retention Among People of Color

Retention rates in both buprenorphine and methadone treatment are low across all populations, but significantly lower among minorities. Several contributing factors have been identified, including socioeconomic conditions such as unstable housing, unemployment, and lack of psychosocial support prevalent within many minority communities. These factors, along with disparities in treatment of co-occurring disorders and inadequate access to supportive services, contribute to lower retention. Furthermore, the lower dosages of methadone often prescribed to minority patients, even in programs headed by Black directors, are associated with decreased treatment adherence. Implicit biases among healthcare providers may also contribute to the perception of poor retention as a patient failure rather than an outcome of structural disparities.

Policy Recommendations

Addressing these disparities necessitates a multifaceted strategy. Medicaid expansion is crucial for enhancing access to MAT among low-income individuals, particularly minorities. Increasing grant funding for federally qualified health centers to implement buprenorphine treatment can expand access for low-income minority populations. Incentivizing buprenorphine provider training and waiver application in minority communities and leveraging telehealth capabilities can expand access to buprenorphine. Moreover, increasing funding for the national Providers Clinical Support System and promoting collaboration between community health workers and buprenorphine providers within minority communities can also improve access to care. Finally, revising methadone treatment regulations to allow for more flexible and convenient delivery models and ensuring Medicaid coverage for ancillary services—including housing and employment assistance—are crucial steps towards addressing these deeply rooted systemic issues. The overarching goal is to achieve equitable access to effective, less stigmatized, and more convenient MAT options for all individuals with OUD, regardless of race or ethnicity.

Summary

The opioid epidemic in the US disproportionately affects White individuals, yet significant harm also impacts minority populations. While medication-assisted treatment (MAT) using buprenorphine and methadone is effective, access and retention disparities exist among people of color. These disparities stem from a complex interplay of factors, including provider shortages in minority communities, stigma surrounding MAT, particularly methadone, historical discriminatory practices, and systemic barriers to care.

Barriers to Treatment: A History of Segregation and Discrimination

Disparities in accessing MAT for people of color are rooted in historical and ongoing systemic issues. Limited provider availability, especially those accepting Medicaid, within minority communities creates significant access barriers. Furthermore, interpersonal discrimination and fear of reporting to authorities deter help-seeking behavior. Treatment facilities serving primarily minority populations are less likely to offer MAT, possibly due to provider shortages or administrative decisions. The higher prevalence of Medicaid among people of color further exacerbates access problems due to the limited acceptance of Medicaid by many MAT providers.

Methadone Treatment Among People of Color: A Trifecta of Stigmas

The disproportionate distribution of buprenorphine (predominantly to White populations) and methadone (more often to people of color) reflects deeply rooted stigmas. Methadone, historically viewed as a tool for crime control, carries significant stigma, reinforced by its historical association with punitive treatment programs predominantly serving minority communities. This, combined with the existing stigma surrounding OUD and racial discrimination, creates a complex barrier for people of color accessing effective treatment. The stricter regulations and less convenient delivery system for methadone compared to buprenorphine further compounds these issues. The geographical distribution of providers reinforces this disparity.

Disparities in Treatment Retention Among People of Color

Retention rates for MAT are low across all populations, but significantly lower among people of color. This can be attributed to several factors, including socio-economic disadvantages prevalent in minority communities (unstable housing, unemployment, lack of psychosocial support), inadequate treatment of co-occurring disorders, lower methadone dosages in programs serving primarily minority clients, and the experience of intersecting stigmas. These issues often manifest as poor treatment adherence and involuntary discharges.

Policy Recommendations

Addressing these disparities requires a multifaceted approach. Medicaid expansion in all states is crucial to enhance access for low-income individuals, with a focus on improving outcomes for Black populations. Increased grant funding for federally qualified health centers to implement buprenorphine treatment will expand access to underserved communities. Strategies to increase buprenorphine provider training and placement in minority communities are essential, along with leveraging telehealth capabilities. Regulatory changes to make methadone treatment more flexible and convenient can reduce stigma and improve access. Finally, covering comprehensive ancillary services (addressing co-occurring disorders, housing, and employment) through Medicaid will significantly improve treatment retention rates.

Conclusion

Racial and ethnic disparities in accessing and maintaining MAT for OUD demand immediate attention. A comprehensive strategy encompassing policy changes, increased funding, and a focus on addressing systemic inequities is necessary to achieve equitable access to effective treatment for all.

Summary

The opioid crisis in the US disproportionately affects white individuals, overshadowing the significant impact on people of color. While white individuals experience higher rates of opioid misuse and death in most states, deaths from synthetic opioids increased dramatically among Black and Hispanic populations between 2013 and 2017, exceeding the increase seen in white populations. Despite effective medication-assisted treatment (MAT) options like buprenorphine and methadone, significant barriers hinder access for people of color.

Barriers to Treatment

Numerous factors contribute to the unequal access to MAT for people of color. These include a shortage of providers, especially those accepting Medicaid, in communities of color; interpersonal discrimination; and a lower likelihood of SUD treatment facilities in diverse communities offering MAT. The fear of discrimination and potential legal repercussions further discourages help-seeking behavior among people of color.

Methadone Treatment and Stigma

White populations are more likely to receive buprenorphine, while people of color disproportionately receive methadone, the more stigmatized option. Methadone's historical association with crime control, particularly during the Nixon administration, has fueled negative perceptions. This stigma, coupled with the existing stigma surrounding OUD and racial bias, creates a significant barrier to effective treatment. Methadone's stricter regulations (daily supervised dosing, limited take-home medication) further compound the challenges for patients, many of whom experience disruptions to work and childcare. Buprenorphine, conversely, offers greater convenience and confidentiality.

Disparities in Treatment Retention

Retention rates in MAT are low across all populations, but even lower for people of color. Several factors contribute to this, including community deterioration (higher rates in communities of color), lack of psychosocial support, unstable housing and employment, unreliable transportation, and inadequate treatment for co-occurring SUDs. Lower methadone dosages in facilities with higher proportions of people of color further hinder retention. Implicit biases within healthcare can also negatively impact retention rates.

Policy Recommendations

Addressing these disparities requires a multi-pronged approach. Expanding Medicaid in all states is crucial to increase access to MAT for low-income individuals. Increased grant funding for federally qualified health centers to implement buprenorphine treatment, particularly in communities of color, is vital. Incentivizing providers to work in diverse communities and expanding telehealth options would increase buprenorphine accessibility. Making methadone treatment more flexible and convenient, such as allowing take-home doses and office-based administration, would reduce stigma. Finally, Medicaid should cover comprehensive ancillary services to address co-occurring issues and improve retention.

Summary

The opioid crisis in the US affects everyone, but it's not affecting everyone equally. While many think it's mostly a problem for white people, it's hurting people of color too. Black and Hispanic people have seen huge increases in deaths from strong opioid drugs. Even though there are good medicines to help people with opioid problems, many people aren't getting them.

Why People Aren't Getting Help

There are many reasons why people aren't getting help for opioid use disorder (OUD). One big reason is stigma – people think it's a personal failing, not an illness. Another reason is that the medicines used to treat OUD are sometimes wrongly seen as just another drug. There aren't enough doctors who can prescribe these medicines, and insurance can make it hard and expensive to get help.

Different Medicines, Different Problems

There are two main medicines for OUD: buprenorphine and methadone. Methadone is more heavily regulated and carries a lot of stigma, especially in communities of color. This is due to its history being connected to crime control and social control of minority communities. Many of these programs have rules that make it harder for people to get their lives back on track, like daily visits. Buprenorphine is easier to get, but many people of color have trouble accessing it because of where these services are located and because of insurance issues.

Staying in Treatment: More Challenges

Even when people start treatment, it's hard to stay with it. People of color have a harder time than white people staying in treatment. This is because of things like lack of housing or jobs, trouble getting to appointments, and not getting help with other problems, like drug or alcohol problems.

Making Things Better

To fix these problems, we need to do several things. We need to expand health insurance to help more people afford treatment. We need to give money to clinics to help more people get buprenorphine treatment, especially in areas with many people of color. We also need to make methadone treatment easier to get and less stigmatized. Finally, we need to make sure people get other help they need, like help finding housing and jobs. Everyone deserves a chance to get better.