Title: Racial/ethnic disparities in access to buprenorphine among Medicare disability beneficiaries Authors: Please enter the full name, degree, and organization/institutional information for all co-authors, using a line break between authors Thuy Nguyen, PhD, MA; University of Michigan; Institute for Health, Health Care Policy and Aging Research, Center for Health Services Research Sumedha Gupta, PhD, MA, MSc; Indiana University Purdue University Indianapolis Engy Ziedan, PhD, MA; Tulane University Hillary Samples, PhD, MHS; Rutgers University Institute for Health, Health Care Policy and Aging Research, Center for Health Services Research; School of Public Health, Department of Health Behavior, Society and Policy Stephen Crystal, PhD; Rutgers University Institute for Health, Health Care Policy and Aging Research, Center for Health Services Research Kosali Simon, PhD; Indiana University, Paul O’Neil School of Public and Environmental Affairs Abstract: Background/Objectives: COVID-19 has disrupted the progress toward reversing the opioid epidemic. Following the national emergency declaration on March 13, 2020, pandemic disruptions in provision of healthcare are associated with slowdown in initiation and sustenance of medicated assisted treatment for opioid use disorders (MOUD) and may have contributed to the over 81,000 drug overdose deaths in the United States in the 12 months ending in May 2020, the highest number of overdose deaths ever recorded in a 12-month period. Racial/ethnic minorities have borne disproportionately high rates of COVID-19 related morbidity and mortality. Yet it remains unknown whether different racial and ethnic patient populations have been differentially impacted by disruptions in access to MOUD during the pandemic. Methods: The study used retail pharmacy claims from Symphony Health, a US database that includes 92% of all retail pharmacy sales of MOUD products in the US. In samples stratified by patient race and using an interrupted time series approach, this cross-sectional retrospective cohort study examined trends in per-capita rates of patients receiving prescription dispensations for – buprenorphine, vivitrol and naloxone - US Food and Drug Administration–approved medications for treatment of OUD, before and after the national emergency declaration on March 13, 2020, in response to the COVID-19 pandemic. Additionally, we examine, by patient race/ethnicity (White, Black, Hispanic), changes in the share of prescriptions with 14+ days of supply, to assess whether prescribers may have attempted to compensate for decreased access to clinicians following the emergency declaration, by authorizing longer running prescriptions. Results: In the pre-pandemic period prescription dispensing of buprenorphine for MOUD was trending upward. Trend in prescription dispensing of buprenorphine flattened across all racial/ethnic groups (after significantly declining by 2-4% relative to pre-pandemic trends), during the COVID-19 period and following the national emergency declaration, and even turned negative for the white patient population. Although trends in buprenorphine prescribing only flattened (did not turn negative) for non-white patient groups, we found statistically significant or sudden declines in the level of buprenorphine prescriptions in March (intercepts) to Black (-3%, p=0,002) and Hispanic patients (-4%, p=.007). At the same time, the prescription dispensing of Naloxone, which was declining for all racial/ethnic subpopulations prior to the pandemic, began to significantly increase (trend and intercept) for Hispanic patients (while continuing to decline in other racial/ethnic groups). Considering changes in longer running (with 14+/30+ day’ of supply) prescriptions, we find a significant upward shift (intercept) in the share of 14+day prescriptions for the white and Hispanic patients, and a concurrent decline in trend. The increased days’ supply may have helped compensate for decreased access to clinicians following the emergency declaration and the concurrent decline in trend would ensure no net change in the length of MOUD prescriptions to white and Hispanic patients in the long run. The trend in the share of 14+ days MOUD prescriptions to Black patients also significantly declined during COVID-19, even though there was no compensatory level increase in longer prescriptions dispensed to Black. Conclusions: COVID-19 may have undone gains of numerous educational and policy efforts in curbing the opioid epidemic, and further increased disparities in access to recommended MOUD by racial/ethnic minorities. ---------------------------------------------------------- Sumedha Gupta, Associate Professor Department of Economics, IUPUI Affiliate Scientist, Regenstrief Institute, Indiana University School of Medicine Cavanaugh Hall 523, 425 University Boulevard, Indianapolis, IN 46202 317-278-7218 | sugupta@iu.edu<mailto:sugupta@iu.edu> | twitter<https://twitter.com/DrSumedhaGupta> | website<https://www.sumedhagupta.net/> | Google Scholar<https://scholar.google.com/citations?user=bQqFA4cAAAAJ&hl=en>