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Principal Investigator: Jessica Ann Chen
Organization: UNIVERSITY OF WASHINGTON
Fiscal Year: 2024
Award: $621,047
Funding agency: National Institute on Drug Abuse
Opioid use disorder (OUD) is a common and often fatal chronic condition that can be effectively treated with
medications (MOUD). Agonists (methadone, buprenorphine) are first-line treatments that reduce overdose risk.
Black and Hispanic/Latinx patients are less likely to receive buprenorphine than non-Hispanic White patients.
This raises equity concerns, as buprenorphine may be safer, easier to access and less stigmatizing than
methadone for many patients. The novel coronavirus (COVID-19) pandemic resulted in increased flexibility in
the provision of MOUD, including telemedicine initiations for buprenorphine. These policies may reduce
existing disparities by lowering care barriers but could exacerbate disparities if they are not equally beneficial
across groups. COVID-19-related policy changes present an unprecedented opportunity to examine impacts of
a structural intervention—relaxed MOUD restrictions—on disparities generated by structural racism and
discrimination (SRD). Guided by Public Health Critical Race praxis, which posits that racial/ethnic disparities in
healthcare access are produced by SRD, this project will use mixed methods to evaluate how disparities in
MOUD access may have changed in response to COVID-19-related policies in the Veterans Health
Administration (VA), the nation's largest provider of substance use care, and how SRD contributes. Unequal
access to buprenorphine is a significant problem nationally—studies estimate that Black patients with OUD are
50-60% less likely to access buprenorphine compared to White patients with similar disparities observed
among Hispanic/Latinx patients. The proposed research can guide national and health-system-specific policy
decisions regarding the continuation of relaxed MOUD prescribing guidelines post- COVID-19 and where to
target resources to address SRD and its sequelae. Lessons learned from this historical event can influence
future MOUD policy and practice, and it is essential that the impact on disparities and mechanisms underlying
disparities be understood to optimize policy changes with regard to equity. This study aims to: 1) examine how
changes in receipt of MOUD and retention following COVID-19 MOUD policies differ between Black and
Hispanic/Latinx compared to non-Hispanic White patients with OUD; 2) examine how community-level
sequelae of structural racism influence pre/post COVID-19 changes in MOUD receipt for Black and
Hispanic/Latinx patients with OUD; and 3) qualitatively examine experiences of OUD care and perceptions of
implementation of COVID-19-related policies among a sample of Black and Hispanic/Latinx patients with OUD.
Aims 1-2 are observational cohort studies using national VA electronic health record (EHR) data for Black,
Hispanic/Latinx, and non-Hispanic White patients with OUD. Aim 3 uses a qualitative study design involving
semi-structured phone interviews with Black and Hispanic/Latinx VA patients with OUD. A stratified random
sample will be balanced on gender and MOUD receipt pre/post COVID-19. Findings will be disseminated
through national channels to inform future MOUD policies and interventions to improve equity.
Terms: <Adanon><Address><Agonist><Althose><Black><Black race><Buprenorphine><COVID-19><COVID-19 affected><COVID-19 consequence><COVID-19 effect><COVID-19 impact><COVID-19 impacted><CV-19><Caring><Chronic><CoV emergence><CoV pandemic><Cognitive Discrimination><Communities><Coronavirus Infectious Disease 2019><Critical Race Theory><Data><Decrease disparity><Diagnosis><Discrimination><Disparities><Disparity><Dolophine><Dose><Drugs><Electronic Health Record><Equity><Event><Future><Gender><Guidelines><Health Care Systems><Health system><Healthcare Systems><Hispanic><Home><Imprisonment><Individuals from minority><Individuals of minority><Inequity><Integrated Health Care Systems><Interruption><Intervention><Intervention Strategies><Interview><Latine><Latinx><Legal><Life><Lived experience><Lived experiences><Lower disparity><Medication><Methadone><Methadose><Methods><Minority Groups><Minority People><Minority Population><Minority individual><NIDA><Nalorex><Naltrexone><National Institute of Drug Abuse><National Institute on Drug Abuse><Nemexin><Non-Hispanic><Nonhispanic><Not Hispanic or Latino><Opiate agonist><Opiate receptor agonist><Opiates><Opioid><Opioid agonist><Opioid receptor agonist><Outcome><Overdose><Overdose reduction><Pain Control><Pain Therapy><Pain management><Patients><Pattern><Perception><Persons><Pharmaceutical Preparations><Phone><Police><Policies><Provider><Public Health><Qualitative Methods><Race><Races><Racial Group><ReVia><Regulation><Relaxation><Research><Research Design><Research Resources><Resources><Sampling><Series><Shapes><Stigmatization><Structural Racism><Structure><Study Type><System><Technology><Telemedicine><Telephone><Time><Veterans Health Administration><Veterans Health Affairs><Violence><Vivitrol><access disparities><access to health care><access to healthcare><accessibility disparities><accessibility of health care><accessibility to health care><accessibility to healthcare><balance disorder><balance impairment><black patient><buprenorphine treatment><clinical practice><cohort><community factor><community-level factor><corona virus emergence><coronavirus disease 2019><coronavirus disease 2019 consequence><coronavirus disease 2019 effect><coronavirus disease 2019 impact><coronavirus disease-19><coronavirus disease-19 impact><coronavirus emergence><coronavirus infectious disease-19><coronavirus pandemic><design><designing><develop therapy><disparate effect><disparate impact><disparate result><disparities in access><disparities in race><disparity due to race><disparity in care><disparity in ethnic><disparity in healthcare><disparity reduction><disturbed balance><drug/agent><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><emergent CoV><emergent corona virus><emergent coronavirus><emerging CoV><emerging corona virus><emerging coronavirus><equilibration disorder><equilibrium disorder><ethnic based disparity><ethnic disadvantage><ethnic disparities in health><ethnic disparity><ethnic health disparity><ethnic inequality><ethnic inequity><ethnicity disparity><experience><federal policy><flexibility><flexible><health care access><health care availability><health care disparity><health care inequality><health care inequity><health care service access><health care service availability><healthcare access><healthcare accessibility><healthcare availability><healthcare disparity><healthcare inequality><healthcare inequity><healthcare service access><healthcare service availability><homes><improved><incarcerated><incarceration><inequality due to race><inequality in access><inequitable effect><inequitable impact><inequitable outcome><inequity due to race><inequity in access><inequity in accessibility><integrated health system><integrated healthcare systems><integrated system of care><intervention development><interventional strategy><lens><lenses><medication for opioid use disorder><mitigate disparity><nCoV><new CoV><new corona virus><new coronavirus><novel CoV><novel corona virus><novel coronavirus><observational cohort study><opiate crisis><opiate overdose><opiate related overdose><opiate use disorder><opioid crisis><opioid drug overdose><opioid epidemic><opioid induced overdose><opioid intoxication><opioid medication overdose><opioid overdose><opioid poisoning><opioid related overdose><opioid toxicity><opioid use disorder><outcome disparities><outcome inequality><outcome inequity><overdose risk><pain treatment><post-COVID><post-COVID-19><post-coronavirus disease 2019><qualitative reasoning><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial disparity><racial inequality><racial inequity><racial origin><racial population><racial subgroup><racially unequal><reduce disparity><reduce overdose><reduction in disparity><reduction in overdose><residential segregation><resilience><resilient><response><stem><study design><substance use><substance using><telehealth><therapy development><treatment development><unequal effect><unequal impact><unequal outcome><violent><violent behavior>