Addressing racial & socioeconomic disparities in access to medications for opioid use disorder amid COVID-19.
Addressing racial & socioeconomic disparities in access to medications for opioid use disorder amid COVID-19.
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DOI：
10.1016/j.jsat.2020.108214
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发表时间：
2021-03
影响因子：
3.9
通讯作者：
Nguemeni Tiako MJ
中科院分区：
文献类型：
--
作者：
Nguemeni Tiako MJ
2019 年冠状病毒病 (COVID-19) 大流行造成了毁灭性的公共卫生危机，给美国的医疗保健服务带来了重大挑战。医疗保健系统实施的变化以及社会服务提供的变化影响了解决当前阿片类药物流行病的努力，并可能加剧阿片类药物使用障碍 (OUD) 治疗方面现有的种族/民族和社会经济差距。在 COVID-19 之前，研究被忽视，媒体也将 OUD (MOUD) 药物获取方面的种族差异以及围绕阿片类药物流行病的黑人社区中阿片类药物过量的发生率排除在报道之外（James & Jordan，2018）。除了黑人、西班牙裔和原住民中的 COVID-19 死亡率不成比例地高之外（Gross 等，2020），大流行带来的社会状况也加剧了阿片类药物流行病的日益恶化的影响，有记录的过量用药激增。最近的一项研究表明，与没有 SUD 的人相比，最近被诊断为物质使用障碍 (SUD) 的人，尤其是那些患有 OUD 的人，患 COVID-19 的风险显着增加。研究还发现，患有 OUD 的黑人感染 COVID-19 的风险更大，并且与白人相比，患有 OUD 和 COVID-19 的黑人住院和死亡的几率更大（Wang 等人，2020）。先前存在的获取 MOUD 的差异可能会导致患有 OUD 的黑人感染 COVID-19 的风险增加。本评论旨在解决后者，分为三个部分。首先，我概述了美国在获得阿片类激动剂疗法方面存在差异的历史和现有情况。然后，我概述了为应对 COVID-19 大流行而对 MOUD 的规定进行的变更。最后，我提出短期和长期解决方案，以解决在获得 MOUD 方面的种族和社会经济差异。
The coronavirus disease 2019 (COVID-19) pandemic has created a devastating public health crisis, posing significant challenges for health care delivery in the US. The changes that the health care system implemented and the changes in the provision of social services have impacted efforts to address the ongoing opioid epidemic, and may worsen existing racial/ethnic and socioeconomic disparities in access to treatment for opioid use disorder (OUD). Pre-COVID-19, research overlooked and the media excluded from its coverage the racial disparities in access to medications for OUD (MOUD) and the increasing rates of opioid overdoses in Black communities surrounding the opioid epidemic (James & Jordan, 2018). Along with the disproportionately high rates of COVID-19 deaths among Black, Hispanic, and Native people (Gross et al., 2020), the social conditions that the pandemic has brought about are adding to the worsening impact of the opioid epidemic with documented overdose spikes. A recent study showed that people with a recent diagnosis of substance use disorder (SUD), and even more so those with OUD, were at significantly increased risk of COVID-19 compared to people without SUDs. The study also found that Black people with OUD were at greater risk of COVID-19, and Black people with OUD and COVID-19 had greater odds of hospitalization and mortality compared to their white counterparts (Wang et al., 2020). The preexisting disparities in access to MOUD may be contributing to the increased risk of COVID-19 among Black people with OUD. This commentary seeks to address the latter, and is organized in three parts. First, I give an overview of the history and existing landscape of disparities in access to opioid agonist therapies in the US Then, I provide an overview of changes to the provision of MOUD in response to the COVID-19 pandemic. Last, I propose short-and long-term solutions to address racial and socioeconomic disparities in access to MOUD.
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