Better Together: Integrating MOUD in African American Community Settings

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Racial disparities in engagement and retention in treatment with medication treatment for opioid use disorder (MOUD) are profound and persistent and have devastating consequences. Black/African American persons have experienced the fastest increases in opioid overdose deaths nationally since 2013 and now have higher rates of overdose deaths than whites [1,2]. COVID-19 has accelerated overdose deaths especially among Black/African Americans: during 2020, the number of Black persons dying from an opioid overdose increased by 45% compared to the previous year, nearly double the increase for white overdose deaths [3]. Despite the great need for MOUD, Black/African Americans are substantially less likely than whites to receive MOUD, especially buprenorphine, and have substantially lower rates of MOUD treatment retention [4-8]. These differences in MOUD treatment engagement and retention persist even when controlling for socioeconomic factors and despite reducing barriers to MOUD (e.g., expanding Medicaid eligibility, eliminating co-pays or prior authorization requirements) and increasing its availability in a broad range of medical settings (e.g., medical offices, clinics, federally qualified health centers, and Emergency Departments) [8-13]. Our own and others’ research identify that stigma, medical mistrust, fear of legal consequences, and bias and misunderstanding about MOUD contribute to underutilization of MOUD in Black/African American populations [14-17]. To address these barriers, outreach, engagement, and reengagement by community-based Peer Recovery Specialists (PRS, trained individuals with shared lived experience of SUD recovery), providing MOUD in a broader range of settings and by telemedicine, and a collaborative care model integrating provision of substance use disorder treatment generally or MOUD with buprenorphine (supported by telemedicine) in trusted, community sites, including churches or faith-based or secular community organizations, have been found to be feasible and attractive to Black/African American persons with untreated OUD [18-26]. Additional research is needed, however, to evaluate barriers and facilitators for implementation of a collaborative care model integrating provision of MOUD with buprenorphine and provision of PRS services in community-based sites and to evaluate the effectiveness of this MOUD care model compared to MOUD with buprenorphine provided in medical offices or clinics for urban Black/African Americans with OUD.