There Remain Startling Health Inequities in the Treatment of Substance Use Disorder

Many experts agree that substance use disorder (SUD) is the leading public health concern of the 21st century, with 40.3 million Americans age 12 years and older living with alcohol use disorder, an illicit drug use disorder, or both.¹ Among the general population, only 18% of individuals with SUD receive treatment.² This alarming gap is even more pronounced among Black, Indigenous, and people of color, or BIPOC, communities. By way of example, only 10% of African Americans, 8% of Latinx individuals, and 3.5% of Native Americans (American Indians and Alaska Natives) with SUD receive treatment. ^3-5

The obstacles to accessing treatment for SUD―in minority communities and across society as a whole―are myriad and complex. For patients with SUD, remaining on the path toward long-term recovery can be challenging, with stigmas associated with SUD exacerbating things further. It is imperative that, as a country, we move beyond these stigmas and offer improved screening models and increase access to treatment, as well as ensure that individuals with SUD have the lifelong tools and critical support needed to break the cycle of addiction and prevent future relapse.

The inequities in SUD treatment are clear—between 2016 and 2020, the United States saw more than 116,000 excess premature deaths among racial minority groups, ethnic minority groups, and Indigenous populations resulting from mental and behavioral health concerns.⁶ It has also been reported that drug overdose death rates are the highest among Indigenous people and Black men. In fact, death rates for Black men between the ages of 35 and 64 years have tripled since 2018 due to illegal drugs laced with fentanyl, a high-potency opioid.⁷

Among the underlying causes in the inequity equation is the lack of adequate health insurance. Twelve states have not adopted the Affordable Care Act (ACA)’s Medicaid expansion, which extends Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level. Seven of these 12 states are in the southeast, where a majority of the USBlack population resides. Since Medicaid is the largest payer of mental health services in the United States, data in states that have adopted the ACA Medicaid expansion have demonstrated that these states have higher rates of treating patients with SUD.⁸

The utilization of buprenorphine to treat opioid use disorder (OUD) and reduce the risk of overdose, or the lack thereof, is another critical factor. The duration of buprenorphine treatment is a measure of quality of care, and longer retention is associated with superior clinical outcomes. But racial and ethnic minority patients are more likely to discontinue buprenorphine treatment earlier than White patients.⁹ The reasons for this are unknown and must be investigated further if we are to close the racial and ethnic gap in effective SUD treatment.

Inequities in SUD treatment are also affected by social determinants of health, such as geographic location, socioeconomic challenges, and the safety and public health infrastructure of communities. Cultural barriers play a major role as well, particularly as it pertains to the perceived stigma surrounding treatment for SUD and other behavioral health concerns across many minority communities.

SUD can destroy the lives of individuals and families it impacts, as well as society as a whole in countless ways, including financially. Between 2016 and 2020, among Indigenous populations and racial and ethnic minoritized groups alone, the total excess cost burden from premature mental and behavioral health-related deaths due to mental illness, SUD, and suicide is $278 billion.¹⁰

Knowing full well that BIPOC populations are at greater risk, one crucial and attainable step we can take in beginning to resolve inequities in SUD treatment is to provide culturally relevant information and support. We must expand direct access to care, ideally delivered by providers who understand the inherent concerns among specific populations. Culturally informed care is essential―particularly among communities such as American Indians and Alaska Natives (AI/AN), who may face additional stressors due to historical trauma. Language barriers present yet another concern, and the need for Spanish-speaking recovery coaches and bilingual support systems is also vital.

With proper treatment and long-term support, lasting recovery from SUD is possible. Everyone deserves access to care that will help them regain control of their lives. Yet when it comes to the rate of minority populations receiving treatment for SUD, much work remains. Only in acknowledging the shortcomings, policies, stigmas, and barriers that contribute to the current inequities in SUD treatment can we bring about necessary change.

About the Author

Hans Morefield is the CEO of CHESS Health, the leading provider of evidence-based digital health solutions addressing the individual and societal crisis of SUD.

References

1. 2020 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Published October 25, 2021. Accessed January 25, 2023. https://www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases
2. Jordan, Mathis, Isom.Achieving Mental Health Equity: Addictions. Psychiatric Clinics of North America. Volume 43, Issue 3. Published September 2020. Accessed January 25, 2023. https://www.sciencedirect.com/science/article/abs/pii/S0193953X20300319?via%3Dihub
3. 2019 National Survey on Drug Use and Health: African Americans. Substance Abuse and Mental Health Services Administration. Published September 2020. Accessed January 25, 2023. https://www.samhsa.gov/data/sites/default/files/reports/rpt31099/2019NSDUH-AA/AfricanAmerican%202019%20NSDUH.pdf
4. 2019 National Survey on Drug Use and Health: Hispanics. Substance Abuse and Mental Health Services Administration. Published September 2020. Accessed January 25, 2023. https://www.samhsa.gov/data/sites/default/files/reports/rpt31101/2019NSDUH-Hispanic/Hispanic%202019%20NSDUH.pdf
5. Alcohol and Drug Abuse Among Native Americans. American Addition Centers. Published September 12, 2022. Accessed February 15, 2023. https://americanaddictioncenters.org/rehab-guide/addiction-statistics/native-americans
6. The Economic Burden of Mental Health Inequities in the United States Report. Satcher Health Leadership Institute at Morehouse School of Medicine. Published September 2022. Accessed January 25, 2023. https://satcherinstitute.org/wp-content/uploads/2022/09/The-Economic-Burden-of-Mental-Health-Inequities-in-the-US-Report-Final-single-pages.V6.pdf
7. Han, Einstein, Jones, et al. Racial and Ethnic Disparities in Drug Overdose Deaths in the US During the COVID-19 Pandemic. JAMA Network. Published September 20, 2020. Accesses January 27, 2023. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796547?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=092022
8. Grooms, Ortega. Racial Disparities in Accessing Treatment for Substance Use Highlights Work to Be Done. USC Leonard D. Schaeffer Center for Health Policy & Economics. Published April 29, 2022. Accessed January 27, 2023. https://healthpolicy.usc.edu/evidence-base/racial-disparities-in-accessing-treatment-for-substance-use-highlights-work-to-be-done/#:~:text=According%20to%20SAMHSA%2C%20of%20individuals,%25%20of%20the%20time%2C%20respectively.
9. Dong, Stringfellow, Russell, et al. Racial and Ethnic Disparities in Buprenorphine Treatment Duration in the US. JAMA Psychiatry. Published November 9, 2022. Accessed January 27, 2023. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2798512?guestAccessKey=98ccf8b9-2207-4814-9bce-9b62cb92b500&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=110922#yld220008r1
10. The Economic Burden of Mental Health Inequities in the United States Report. Satcher Health Leadership Institute at Morehouse School of Medicine. Published September 2022. Accessed January 25, 2023. https://satcherinstitute.org/wp-content/uploads/2022/09/The-Economic-Burden-of-Mental-Health-Inequities-in-the-US-Report-Final-single-pages.V6.pdf