Behind SUD Disparities: Patient and Provider Perspectives at Mass General Brigham

Abstract

In 2021, Mass General Brigham (MGB), the largest health system in Massachusetts, identified disparities in access and treatment to substance use disorders (SUDs) within their health system as part of their United Against Racism initiative. They found that Black, Latinx, and non-English speaking patients are less likely to be screened for alcohol and opioid use disorder. They are also less likely to be prescribed medication for alcohol use disorder and buprenorphine for opioid use disorder. Buprenorphine treatment is widely recognized in medical and harm reduction circles as an evidence-based intervention and as one of the most effective treatments for opioid use disorder (Soyka, 2017).  However, our study suggests that institutional and systemic barriers persist in facilitating equitable access to Buprenorphine treatment and to other substance use-related care across MGB.This presentation highlights findings from a qualitative study conducted by the authors at the Institute for Community Health (ICH) in partnership with MGB. The study expands beyond health belief model (HBM) -informed research, which encourages patient-level analysis of health beliefs and barriers (Rosenstock, 1966). We apply ecological and structural theoretical models to identify equity-oriented solutions (Cohen et al., 2000; Farahmand, Arshed, & Bradley, 2020; Jones,2000). Methods include qualitative interviews with MGB staff (n=29) to obtain a robust understanding of gaps in MGB’s SUD care system; interviews with MGB patients (n=8), ongoing reflective dialogues with MGB leadership, and review of literature.