Black Medicaid patients face deadly delays in opioid treatment

As the nation has grappled with a deadly opioid epidemic over the past two decades, Black communities have faced a crisis of their own. From 2010 to 2019, Black Americans went from being the least likely to die from an opioid overdose to dying at higher rates than white opioid users, according to federal data.

A new study published Monday offers insight into why.

Researchers found that Medicaid enrollees newly diagnosed with opioid use disorder, or OUD, often wait months before receiving treatment, and that Black patients face some of the steepest barriers to accessing potentially life-saving medications such as methadone and naloxone.

The study found that Medicaid patients can wait up to six months to begin treatment, despite medical consensus that people with OUD should receive medication as quickly as possible. As a result, many patients never receive drugs proven to reduce opioid cravings and lower the risk of overdose.

The findings also highlight how longstanding health care disparities continue to shape overdose outcomes, particularly for Black Americans, who are disproportionately likely to rely on Medicaid for coverage.

“The study shows a critical need for policies that ensure people can access treatment regardless of where they live, how much money they make, or other personal characteristics,” said Peter Treitler, a Boston University professor who specializes in substance use disorder and co-authored the research.

But with sweeping Medicaid cuts looming, those policy changes may not arrive anytime soon.

The study, conducted by researchers at Boston University and Rutgers University, analyzed medical records from nearly 1.2 million Medicaid enrollees ages 18 to 64 who were newly diagnosed with OUD across 44 states. The data included patients addicted to heroin, prescription painkillers and fentanyl, a potent synthetic opioid. Many participants also had chronic pain, psychiatric disorders or substance use disorders involving drugs other than opioids.

Medication-based treatment, particularly methadone and buprenorphine, has long been shown to reduce withdrawal symptoms, curb cravings and lower overdose risk. Another medication, naltrexone, blocks the effects of opioids but is generally considered less effective for preventing overdose.

The new study is among the first to examine access to and outcomes for all three medications among newly diagnosed Medicaid patients nationwide.

Researchers found what they described as a modest improvement in treatment access: between 27% and 34% of patients received medication within six months of diagnosis. Still, nearly 69% did not receive any medication during that period.

Black patients were about one-third less likely than white patients to receive methadone or other medications to treat OUD.

Among the 31% of patients who did receive medication, overdose rates within 180 days were significantly lower, particularly for those prescribed methadone or buprenorphine. Patients receiving naltrexone experienced higher overdose rates by comparison.

Timely access to treatment is essential, Treitler and other researchers said, especially for people who depend on public insurance. The study’s authors called for reforms to reduce barriers, including expanded access to take-home methadone doses that can be self-administered outside of clinics.

“Interventions should increase the use of medications for opioid use disorder and provide supports that reduce treatment dropout,” the study concluded.

The findings come as national overdose deaths have begun to decline. Data released earlier this year by the Centers for Disease Control and Prevention showed a nearly 27% drop in opioid overdose deaths in 2024, the first significant decrease since 2019.

But overdose rates among Black Americans remain disproportionately high, with Black men among the most at-risk populations nationwide.

Opioid overdose deaths among Black Americans began rising sharply in 2010. From 2019 to 2020, deaths surged by 44%, marking the first time overdose deaths among Black Americans surpassed those of white Americans. The crisis has been especially severe among Black youth ages 15 to 24, with overdose deaths increasing by 86% in 2020 alone.

Researchers warned that recent gains could be reversed as access to treatment becomes more restricted.

The study found that methadone reduced overdose risk by 86% compared with receiving no medication, the strongest protective effect among the treatments analyzed.

At the same time, pending federal budget cuts threaten to undermine treatment access. The One Big Beautiful Bill Act, signed into law by President Donald Trump in July, includes deep reductions to Medicaid funding, the primary source of insurance for addiction treatment in the United States.

That same month, the Trump administration delayed funding for the CDC’s Overdose Data to Action program, proposing a $140 million reduction, about half of the program’s previous budget. Addiction researchers warned the cuts could result in more than 156,000 people losing access to treatment and lead to roughly 1,000 additional overdose deaths annually.

There is no public indication that the delayed funds have since been released.

The study’s authors urged policymakers to protect Medicaid funding and expand access to medication-based treatment, warning that failure to do so could halt or reverse recent declines in overdose deaths.

“Increasing access to methadone may be crucial,” the authors wrote, “given its large protective effect against overdose and the substantial policy and service-delivery barriers to access.”

This article first appeared in Word in Black. It has been edited for style. For more information, visit www.wordinblack.com.