A Scoping Review of Psychosocial Factors Influencing Racial/Ethnic Disparities in Access and Outcomes of Medication Treatment for Opioid Use Disorder in the United States

Background and Purpose: Medications for opioid use disorder (MOUD) successfully treat opioid use disorder (OUD) and prevent overdose, yet remain under-utilized among racial and ethnic minorities (R/EMs). We conducted a scoping review to better understand barriers and facilitators to MOUD treatment among R/EMs, and to highlight the state of knowledge related to psychosocial factors that contribute to or reduce disparities in MOUD access/utilization among R/EMs.

Methods: Literature was gathered, screened, and analyzed (May 2024 to April 2025), using PsycINFO and PubMed databases. Inclusion criteria were 1) published in 1999 or later (i.e., after the opioid epidemic onset), 2) conducted in the US, 3) presented empirical data (quantitative, qualitative) relating to the treatment of people with primary OUD, 4) involved racial/ethnic disparities, comparisons and/or race-specific information, and 5) assessed at least one psychosocial factor contributing to disparities. Abstracts (n=1960) were screened by four reviewers. Studies meeting inclusion criteria (n=46) were read as full-text by two reviewers to guide data extraction, analysis, and synthesis. We used the five Social Determinants of Health (SDOH) domains to code psychosocial factors.

Results: Studies spanned geographic regions: National (n=19, 41.3%); Northeast (n=14, 30.4%); South (n=9, 19.6%); West (n=7, 15.2%); Midwest (n=5, 10.9%); and unknown (n=1, 2.2%). The most common MOUD types examined were: buprenorphine (n=13, 28.3%); buprenorphine and methadone (n=11, 23.9%); and buprenorphine, methadone, and naltrexone (n=10, 21.7%). Most studies used quantitative methods (n=35, 76.1%), whereas few used qualitative (n=9, 19.6%) or mixed methods (n=2, 4.3%). Articles focused on Black/African American (n=38, 82.6%), Hispanic/Latinx (n=25, 54.3%), American Indian/Alaska Native (n=13, 28.3%), Asian (n=4, 8.7%), and Native Hawaiian/Other Pacific Islander populations (n=2, 4.3%), as well as R/EMs broadly (n=6, 6.5%). Few articles (n=9, 19.6%) examined MOUD treatment outcomes. Studies involved psychosocial factors within the SDOH domains as follows: healthcare access and quality (n=44, 95.7%), economic stability (n=16, 34.8%), social and community context (n=16, 34.8%), neighborhood and built environment (n=15, 32.6%), and education access and quality (n=6, 13.0%).

Conclusions and Implications: This study provides an exploratory, rigorous review of the literature regarding psychosocial factors that contribute to MOUD treatment disparities among R/EMs. Our synthesis of articles provides recommendations that can guide MOUD policy and practice. We recommend treatment directors, providers, and health services researchers consider these findings to improve access to care for racially marginalized populations. Future research should focus on MOUD outcomes among R/EMs. Moreover, additional qualitative studies would be valuable in understanding the relevant perspectives and MOUD treatment experiences of people who are R/EMs.