“A Lack of Empathy:” A qualitative study of Black people seeking treatment for opioid use disorder

Abstract

Racial inequities in the treatment of opioid use disorder (OUD) are an urgent and insidious issue, especially in the context of the national opioid overdose crisis. Medications for opioid use disorder (MOUD) are the standard of care and indisputably reduce morbidity and mortality from OUD. However, a racial treatment gap persists, with Black patients less likely to receive MOUD when compared to white patients. In this study, we seek to evaluate the experiences of Black individuals with OUD in seeking treatment. Qualitative semi-structured interviews were conducted with 25 participants who self-identified as Black or African-American and had been diagnosed with OUD in Philadelphia, Pennsylvania. Many participants described that their first experiences using buprenorphine involved using non-prescribed buprenorphine to self-manage withdrawal. Participants who had experienced buprenorphine treatment found it to be an effective treatment. Participants perceived the delivery of methadone maintenance treatment to be overly restrictive and unforgiving. The stigma of having a substance use disorder was felt to be compounded by the stigma of being a Black patient, leading to marginalization and discrimination during healthcare encounters. Participants desired compassionate, dignified, and individualized care in their OUD treatment. Given increasing rates of opioid overdoses among Black Americans and persistent disparities in treatment by race and ethnicity, our findings demonstrate the need for interventions that both promote equitable accessibility and flexible delivery of MOUD and interventions that reduce the stigma experienced by Black individuals while seeking addiction treatment.