Over the last two decades or so, as America grappled with a deadly opioid epidemic, the Black community dealt with a full-blown crisis. From 2010 to 2019, according to data, Black people moved from being the least likely to die from opioid overdose to being more likely to die than white opioid users.
Now, a new, first-of-its-kind study published Monday offers clues about why.
Researchers found that Medicaid enrollees recently diagnosed with opioid use disorder, or OUD, are likely to wait up to six months before accessing treatment — and that Black patients face bureaucratic hurdles blocking them from potentially life-saving, anti-addiction drugs like methadone or naloxone.
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The study results show that the widely accepted addiction protocol that would get OUD patients into treatment as soon as possible isn’t being followed for Medicaid enrollees. This means they are less likely to receive the highly effective drugs that reduce opioid cravings.
But it also reveals how healthcare disparities may play a role in overdose deaths in the Black community — particularly since a disproportionate number of Black people rely on Medicaid for healthcare.
Peter Treitler, a Boston University professor specializing in substance use disorder and a co-author of the study, says the research underscores “the critical need for policies to ensure everyone can access treatment — regardless of where they live, their ability to pay, or other personal characteristics.”
But with drastic, mandated Medicaid cuts on the horizon, those policies may not arrive for the foreseeable future.
The study, conducted jointly by Boston University and Rutgers University, analyzed data of almost 1.2 million Medicaid enrollees who had been recently diagnosed with opioid use disorder. These include addictions to heroin, prescription pain relievers, and fentanyl, a powerful synthetic drug. The subjects ranged in age from 18 to 64 and came from 44 U.S. states; many also suffered from chronic pain, psychiatric disorders, and addiction to drugs other than opioids.
Black Patients Far Less Likely to Have Access to Methadone or Other Treatments
Previous research shows medication treatment — including methadone and buprenorphine, which reduce cravings and withdrawal symptoms — is highly effective in reducing the risk of opioid overdose. Another medication, naltrexone, blocks the effects of opioids.
The new study is among the first to analyze access to and effectiveness of all three medications in people newly diagnosed with OUD in the national Medicaid population.
Results showed what the authors describe as a ‘modest’ improvement — 27% to 34% — in the number of participants who received treatment within six months of diagnosis.
However, 69% of patients surveyed did not receive medication within that time frame. Black participants were a third less likely than white OUD patients to get a methadone prescription or other treatment.
Of the 31% of patients who received medication to treat their addiction, a small number experienced an overdose within 180 days. Overdose was much less likely, however, among those on methadone and buprenorphine than for those using naltrexone.
Timely access to medication is vital, Treitler and others said. Closing the access gap is crucial for individuals who have public or low-cost healthcare and need treatment for a dependency on heroin, painkillers, and other opioids.
To reduce barriers to access, the researchers are calling for reforms such as increasing the availability of ‘take-home’ doses of methadone, which drug users can self-administer without supervision.
“Interventions should increase the use of medications for opioid use disorder and provide supports that reduce treatment dropout,” the study says.
Budget Cuts Could Trigger an Overdose-Death Resurgence
Data from the Centers for Disease Control and Prevention issued earlier this year showed the first significant national drop in overdose deaths since 2019: a nearly 27% reduction in opioid fatalities in 2024. But the death rates for Black Americans were still significantly higher than those of whites, and Black men are among the single highest-risk groups nationwide.
In 2010, opioid overdoses among Black Americans started rising relative to the overall population. From 2019 to 2020, the rate exploded by 44%; it was the first time more Black Americans died from opioid overdoses than whites.
The crisis is particularly acute among Black youth ages 15 to 24. Overdose deaths in that age range soared by an eye-popping 86% in 2020.
The researchers from Boston University and Rutgers University say the current barriers to access issues are particularly concerning. Their findings show that using medication to prevent overdoses can be highly effective.
Their results in particular indicate that methadone reduces overdose risk by 86% — the most significant reduction by a prescription — when compared to receiving no medication at all.
At the same time, the research also warns that pending cuts to Medicaid, the leading source of insurance coverage for addiction treatment in the U.S., will make matters worse. The One Big Beautiful Bill Act, which President Donald Trump signed into law in July, drastically shrinks the program’s budget.
That same month, the Trump administration delayed funding for the CDC’s critical Overdose Data to Action (OD2A) program. The CDC proposed slashing the program’s budget by $140 million, roughly half of prior funding levels.
Addiction researchers warned the cuts “will cause approximately 156,000 people to lose access to treatment for opioid use disorder” and lead to roughly 1,000 additional overdose deaths each year.
At this point, there is no evidence that the delayed funds have been released.
The study’s authors urge policymakers to continue supporting Medicaid so overdose deaths can continue to decline. The OBBBA includes deep cuts to Medicaid and other drug-treatment programs. In 2021, over 1 million adults—roughly 2 in 10 Medicaid enrollees–were being treated for opioid use disorder.
“Increasing access to methadone may be crucial, given its large protective effect against overdose and the substantial policy and service delivery barriers to access.”