Racial/Ethnic Differences in Treatment Utilization and Subsequent Misuse of Prescription Opioids

Background and Purpose: Prescription opioid misuse has seen a considerable increase in occurrence over the past 20 years. These increases are of significant concern, as opioid misuse carries substantial risks of accidental overdose and increased risk for illicit drug and alcohol use. Research on treatment disparities associated with prescription opioid misuse among racial/ethnic groups remains unclear. While Black and Hispanic individuals have similar rates of prescription opioid misuse compared to non-Hispanic White individuals, it is unclear whether there are racial/ethnic differences in the utilization of treatment services specific to prescription opioid misuse. Thus, the purpose of the current study was to explore the role of race and ethnicity in service utilization for prescription opioid specific treatment. 

Methods: Data are from the 2012-2013 National Epidemiologic Survey on Alcohol Related Conditions-III (NESARC-III), a population-representative survey of United States adults aged 18 or older living in non-institutionalized settings. Our sample included respondents who were engaged in prescription opioid misuse prior to the past year (n = 656). Participants reported on many sociodemographic and clinical factors, including race/ethnicity, and whether they had utilized 13 different types of treatment services for prescription opioid misuse prior to the past year. Participants also completed measures associated with prescription opioid misuse in the past year. All analyses were completed using the survey weights provided in the NESARC-III sampling strategy. Analyses examined whether race/ethnicity was significantly associated with treatment utilization and whether racial/ethnic differences in prescription opioid use following treatment utilization exist.

 Results: Only about 8% of individuals engaged in prescription opioid misuse sought treatment. Bivariate analyses showed that Black/African American individuals were less likely than White non-Hispanic individuals to utilize social services, detoxification services, rehabilitation services, methadone services, emergency rooms, and private medical practitioners for prescription opioid misuse. A multivariate logistic regression, controlling for sociodemographic and clinical factors showed that compared to White non-Hispanic individuals, Black/ African American individuals were less likely to utilize any form of treatment for prescription opioid misuse (OR = 0.36, p < .01), as were Hispanic individuals (OR = 0.46, p < .01). Follow-up analyses among those who sought treatment for prescription opioid misuse prior to the past year (n = 262) showed no racial/ethnic differences in past year abstinence from prescription opioids, days since last use of prescription opioids in the past year and past-year diagnosis of opioid use disorder.

 Conclusions and Implications: While there are no racial/ethnic differences in opioid misuse following treatment, results show treatment rates are low, especially among Black/African American and Hispanic individuals. To our knowledge, this study was the first to examine racial/ethnic rates of treatment services for opioid use. Future research is needed to identify potential alternative treatment approaches that are specific to the needs of Black African/American and Hispanic individuals, as Black/African American and Hispanic individuals are underserved in the various treatment sectors. Through improved understanding of racial and ethnic differences and outcomes in prescription opioid misuse treatment, social work practitioners can develop a more effective referral system to improve the accessibility of treatments.