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New research finds people living with disabling conditions are less likely to be prescribed medications for the treatment of opioid use disorder than individuals without disabilities, raising concerns over whether those individuals are experiencing added stigma that is making it harder for them to access treatment.

People with disabilities were 40% less likely to use medications like buprenorphine or methadone, and 13% less likely to use such medications continuously for a period of six months compared to people without a disability, according to the findings of a recent analysis published in JAMA Network Open.

While a number of factors could contribute to people with disabilities having less access to opioid use disorder medications – including physical limitations that could complicate in-person visits to facilities – a general lack of comfort among some clinicians in providing care for either patients with opioid use disorder, or those with a disability, could be behind the disparity, says lead study author Cindy Park Thomas, a professor and associate dean for research at the Brandeis University Heller Graduate School in Massachusetts.

For people with disabilities, whether they’re physical or intellectual, “often you have an intersecting problem of people who have two conditions that could be stigmatizing,” Thomas says.

“The stigma of having a disability combined and the stigma of opioid use disorder can combine and show that people are not really getting care or getting care at a much lower rate than patients who just had one of those conditions.”

In their review of Medicaid enrollees in Washington state, the study authors found that only 38% of individuals with a disabling condition received medication for opioid use disorder compared with 55% of people without a disability, during the years analyzed, from 2016 to 2019. Among those with disabling conditions who received medication for opioid use disorder, 43% had cognitive disabilities, which can include those suffering from autism, stroke, severe mental illness, brain injury and Alzheimer’s disease. That’s compared to 34% of people who had sensory impairments, 33% who had developmental disabilities, and 31% who had mobility limitations.

“There shouldn’t be a clinical reason to be less likely to prescribe medication for opioid use disorder, which is the gold standard,” Thomas says. Studies have found the use of medication combined with counseling is more effective in keeping patients with opioid use disorder in treatment as well as reduce their use of illicit drugs compared with non-drug therapies.

An encouraging finding of the analysis is that the disparity in medication use narrows significantly once individuals with disabilities are finally able to start treatment, Thomas says. The study found that 46% of individuals with a disability continuously used medications for opioid use disorder for six months compared with 50% of people without a disability.

“Once you get them into practice, and once they find providers who are comfortable treating them and treating this intersecting set of conditions, they generally close the gap,” Thomas says. “We think the greatest barrier is getting the right patients to the right providers.”

Yet the study helps to highlight broader concerns regarding the need to address many of the health care inequities individuals with disabilities experience.

More than a quarter of U.S. adults have a disability, according to the Centers for Disease Control and Prevention, yet 1 in 4 of them do not have a regular health care provider, and 1 in 5 had a health care need in the past year that was left unmet due to cost.

Meanwhile, people with disabilities have higher reported rates of opioid use disorder compared with individuals without disabilities, and they are at higher risk rates for a host of other health concerns, including heart disease, diabetes and obesity.

Daniel Lustig, president and CEO of Haymarket Center, a substance abuse treatment facility based in Chicago, says he is optimistic moves by the Biden administration designed to expand access to buprenorphine may lead to greater access for people with disabilities. In December, President Joe Biden signed into law the Mainstreaming Addiction Treatment Act, which included a provision that eliminated the requirement for clinicians to obtain a waiver before they could prescribe buprenorphine.

“The hope would be that it would encourage doctors to prescribe buprenorphine to this population on a much grander scale,” Lustig says.

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