Understanding and addressing racial and ethnic disparities in substance use disorder care: Perspectives from overdose survivors and healthcare providers

Type: Poster Presentation
Date: March 2024

Citation

R Paradise, J Santos, J Desmarais, J Curbera, D Dooley, S Wakeman, “Understanding and addressing racial and ethnic disparities in substance use disorder care: Perspectives from overdose survivors and healthcare providers”, Grayken Center for Addiction Together for Hope: Boston Addiction Conference 2024 (poster presentation)

Abstract

Background: The opioid-related overdose death rate in Massachusetts reached an all-time high in 2022, with growing racial and ethnic disparities. Despite strong evidence showing the effectiveness of using methadone or buprenorphine for treatment of opioid use disorder, there is a significant treatment gap, especially for communities of color. In Massachusetts, studies have shown racial and ethnic disparities in access to any substance use disorder (SUD) treatment post-overdose, use of buprenorphine, and retention in buprenorphine treatment.

Objective: To understand reasons for racial and ethnic disparities in SUD treatment from the perspectives of overdose survivors and healthcare providers, and to identify recommendations for how healthcare systems can improve racial equity in treatment.

Methods: We conducted semi-structured interviews with 59 recent opioid overdose survivors who were living in Boston and identified as Black (18, 31%), Hispanic/Latinx (23, 39%), or White (18, 31%), and with 29 care providers working in a variety of roles at Mass General Brigham (MGB) hospitals and clinics. Interviews explored participants’ experiences with and perspectives on treatment access and equity. Transcripts were coded and analyzed to identify themes relevant to healthcare providers and institutions.

Results: Overdose survivors described common experiences of bias, stigma, and disrespect in healthcare settings, which left them feeling dehumanized. Some shared negative experiences of receiving acute overdose care from a medical professional who offered insufficient or no support around connecting to further SUD treatment or services. Survivors also emphasized that having care team members with lived experience with addiction was important and that they felt most cared for and respected when receiving services at harm reduction programs.  

MGB care staff, including recovery coaches and clinicians, highlighted that although low-barrier evidence-based treatment is widely available at MGB, there are gaps and inconsistencies in SUD identification and referral processes across the system. Participants expressed support for a harm reduction approach to SUD but noted this approach is not consistently implemented by all staff. Finally, care providers’ perspectives illustrated a need for deeper trust-building between providers and patients and between healthcare institutions and patients, particularly in minoritized communities.

Conclusion: Overdose survivors and healthcare staff members identified several factors that impact access to and engagement in treatment for Black and Hispanic/Latinx communities. Healthcare institutions can improve racial equity in SUD treatment by better leveraging existing touchpoints with patients to make connections to care, adopting and institutionalizing a harm reduction approach, and centering trust-building in all patient interactions.

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