Rates of buprenorphine prescribing and racial disparities among patients with opioid overdose

Awareness of the relationship between real-world buprenorphine prescribing and overdose frequency is limited, especially in the Southeastern United States. We described buprenorphine prescribing rates for patients experiencing nonfatal opioid overdoses in the context of overdose frequency.

Electronic medical records review was conducted at an urban, academic hospital in Alabama from January 1 through December 31, 2021. Patients with opioid use disorder (OUD) and nonfatal opioid overdoses, dispositioned from either the emergency department (ED), inpatient, or outpatient affiliated clinics, were identified by International Classification of Diseases-10 codes.

The study included 358 unique patients. Many patients were white (71.5 %), male (59.2 %), and uninsured (54.2 %), with a mean age of 42.0±12.8 years. The majority (85.5 %) experienced one to three overdoses, and 14.5 % of patients had more than three overdoses. The buprenorphine prescription rate increased to 55.8 % when patients had more than three overdoses, compared to one overdose (34.5 %) and two to three overdoses (37.4 %) (p=0.025). Compared to females, more males overdosed more than once (p=0.004). Black patients were less likely to receive buprenorphine prescriptions than white patients (27.3 % vs. 44.5 %, p=0.004). Compared to patients with multiple overdoses, more patients with one overdose had public insurance (p=0.028) and were less likely to present to the ED (p<0.001).

Under-prescribing of buprenorphine is high among patients with OUD and opioid overdoses, even in patients with multiple overdoses, and there appear to be racial disparities in prescribing. Our findings indicate clinical opportunities for improving buprenorphine prescribing and reducing the current disparities.