Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 14:12:100255.
doi: 10.1016/j.dadr.2024.100255. eCollection 2024 Sep.

Association of economic and racial segregation with restricted buprenorphine dispensing in U.S. community pharmacies

Kyle J Moon  1 , Sabriya L Linton  1 , Neda J Kazerouni  2 , Ximena A Levander  3 , Adriane N Irwin  4 , Daniel M Hartung  4
Affiliations

Association of economic and racial segregation with restricted buprenorphine dispensing in U.S. community pharmacies

Kyle J Moon et al. Drug Alcohol Depend Rep. .

Abstract

Background: Timely and reliable dispensing of buprenorphine is critical to accessing treatment for opioid use disorder (OUD). Racial and ethnic inequities in OUD treatment access are well described, but it remains unclear if inequities persist at the point of dispensing.

Methods: We analyzed data from a U.S. telephone audit that measured restricted buprenorphine dispensing in community pharmacies, defined as inability to fill a buprenorphine prescription requested by a "secret shopper." Using the Index of Concentration at the Extremes (ICE), we constructed county-level measures of racial, ethnic, economic, and racialized economic (joint racial and economic segregation) segregation. Logistic regression models evaluated the association of ICE measures and restricted buprenorphine dispensing, adjusting for county type (urban vs. rural) and pharmacy type (chain vs. independent).

Results: Among 858 pharmacies surveyed in 473 counties, pharmacies in the most ethnically segregated and economically deprived counties had 2.66 times the odds (95 % CI: 1.41, 5.17) of restricting buprenorphine dispensing, compared to pharmacies in the most privileged counties after adjustment. Pharmacies in counties with high racialized economic segregation (quintile 2 and 3) also had higher odds of restricting buprenorphine dispensing (aOR 3.09 [95 % CI 1.7, 5.59]; aOR 2.11 [95 % CI 1.17, 3.98]). Similar associations were observed for economic segregation (aOR: 2.18 [95 % CI: 1.21, 3.99]), but not ethnic (0.59 [0.34, 1.05]) or racial (0.61 [0.35, 1.07]) segregation alone.

Conclusions: Restricted buprenorphine dispensing was most pronounced in socially and economically disadvantaged communities, potentially exacerbating gaps in OUD treatment access. Policy interventions should target both prescribing and dispensing capacity to advance pharmacoequity.

Keywords: Opioid use disorder; Pharmacoequity; Structural racism.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kyle Moon reports financial support was provided by Johns Hopkins University Bloomberg School of Public Health’s Health Equity Scholars Program. Ximena Levander reports financial support was provided by Agency for Healthcare Research and Quality (K12 HS026370). Adriane Irwin reports a relationship with Rx Drug Abuse & Heroin Summit that includes: speaking and lecture fees. Adriane Irwin reports a relationship with American Pharmacists Association that includes: travel reimbursement. Daniel Hartung reports a relationship with Alkermes Inc that includes: consulting or advisory. Serving as an unpaid member of the American College of Physicians health policy committee – XAL, Serving as unpaid grants and research committee chair for the National Coalition to Liberate Methadone – XAL, Member of the Oregon Health Authority commission (HERC) that oversees the medical benefit within the state’s Medicaid program – ANI. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Similar articles

See all similar articles

References

    1. ACS and COVID-19: Guidance for using the PUMS with experimental weights, 2022. Integrated Public Use Microdata Series USA. 〈https://usa.ipums.org/usa/acspumscovid19.shtml〉 (accessed 4.22.24).
    1. ACS Table B03002: Hispanic or Latino Origin by Race, 2020. U.S. Census Bureau. 〈https://data.census.gov/table/ACSDT5Y2020.B03002?q=B03002:%20HISPANIC%2... (accessed 10.4.23).
    1. ACS Table B19001: Household Income in the Past 12 Months, 2020. U.S. Census Bureau. 〈https://data.census.gov/table?q=B19001:%20HOUSEHOLD%20INCOME%20IN%20THE...(IN%202020%20INFLATION-ADJUSTED%20DOLLARS)&g=010XX00US$0500000 (accessed 10.4.23).
    1. ACS Table B19001B: Household Income in the Past 12 Months for Black or African American Alone Householder, 2020. U.S. Census Bureau. 〈https://data.census.gov/table/ACSDT5Y2020.B19001B?q=B19001B:%20Househol...(in%202022%20Inflation-Adjusted%20Dollars)%20(Black%20or%20African%20American%20Alone%20Householder)&g=010XX00US$0500000&tid=ACSDT1Y2022.B19001B (accessed 10.4.23).
    1. ACS Table B19001H: Household Income in the Past 12 Months for White Alone, Not Hispanic or Latino Householder, 2020. U.S. Census Bureau. 〈https://data.census.gov/table/ACSDT5Y2020.B19001H?q=B19001H:%20Househol...(in%202022%20Inflation-Adjusted%20Dollars)%20(White%20Alone,%20Not%20Hispanic%20or%20Latino%20Householder)&g=010XX00US$0500000 (accessed 10.4.23).

LinkOut - more resources