Study identifies gaps in hospital-based substance use services that may contribute to racial and ethnic health disparities
Hospitals in communities with a high percentage of Black or Hispanic residents have significantly lower odds of offering hospital-based programs to address opioid use disorder, according to a new study led by researchers at NYU School of Global Public Health. The findings, published in the Journal of Substance Abuse Treatment, suggest that these areas may be missing out on critical programs that increase access to substance use treatment and engage the community around opioid use.
“Given the concentration of health care dollars in hospitals, more attention should be paid to the role that hospitals can play to address disparities in treatment for opioid use disorder—especially those that serve communities with a high concentration of residents of color,” said Ji Eun Chang, assistant professor of public health policy and management at NYU School of Global Public Health and the lead author of the study.
Racial and ethnic disparities in access to outpatient treatment for opioid use disorder are well documented, with Black and Hispanic people less likely to have access to outpatient care or be prescribed buprenorphine, a drug used to treat opioid use disorder. However, less is known about disparities in hospital-based services for opioid use disorder, even though one in seven hospitalized patients have a substance use disorder. A growing body of evidence suggests that treating opioid use disorder in the hospital can lead to high treatment engagement, lower overdose risk, and successful transitions to outpatient care.
To understand the landscape of hospital-based opioid use disorder services and how they vary by the communities they serve, the researchers analyzed a random sample of 446 nonprofit hospitals across the United States. They focused on whether the hospitals prioritized substance use as a critical area of need and whether they offered eight types of programs for addressing opioid use disorder: treatment, primary care, emergency department services, harm reduction and education, programs focusing on social determinants of health, efforts to improve prescribing practices, advocating for policy changes, and community coalition approaches.
“Hospital programs that engage the community allow for culturally relevant approaches to treatment that are informed by factors that are specific to certain communities,” said Chang. “These approaches may be particularly valuable in neighborhoods with historical underinvestment in substance use services.”
The researchers found that two-thirds (67 percent) of hospitals had adopted at least one opioid-related program. Risk education and harm reduction (offered in 34 percent of hospitals), formal treatment (27 percent), and primary care (28 percent) were the three most common programs.
The researchers then looked at the racial and ethnic composition of the counties in which the hospitals were located. Even after controlling for hospital size, the overdose burden in the community, community socioeconomic characteristics, and state funding, hospitals in communities with a high percentage of Black or Hispanic residents were significantly less likely to offer some of the most common programs to address opioid use disorder, including increasing access to hospital-based treatment services, improving prescribing practices, targeted risk education and harm reduction, and community coalitions to address opioid use.
The study also found that states that have expanded Medicaid had greater odds of adopting opioid-related programs, suggesting that expanding access to health care may be a key policy lever to address the opioid epidemic.
The researchers note that hospital-based programs for substance use may be even more critical during the COVID-19 pandemic, a period marked by a sharp increase in overdose deaths and growing racial and ethnic disparities in overdoses.
“With COVID-19 causing significant disruptions to health care and social safety nets, hospital-based or hospital-initiated opioid treatment services are particularly important,” said Chang. “Our study identifies gaps in hospital services that may contribute to continuing racial and ethnic health disparities, but addressing these gaps could play an outsized role in addressing health disparities in access to treatment in a post-pandemic landscape.”
Additional study authors include Zoe Lindenfeld, Alden Lai, and José Pagán of NYU School of Global Public Health and Berkeley Franz and Cory Cronin of Ohio University. The research was supported in part by the Osteopathic Heritage Foundation.
About the NYU School of Global Public Health
At the NYU School of Global Public Health (NYU GPH), we are preparing the next generation of public health pioneers with the critical thinking skills, acumen, and entrepreneurial approaches necessary to reinvent the public health paradigm. Devoted to employing a nontraditional, interdisciplinary model, NYU GPH aims to improve health worldwide through a unique blend of global public health studies, research, and practice. The School is located in the heart of New York City and extends to NYU's global network on six continents. Innovation is at the core of our ambitious approach, thinking and teaching. For more, visit: publichealth.nyu.edu