A new study released today in the NEJM shows how Black patients on Medicare Advantage are dying at a faster rate from opioid/fentanyl overdoses due to patient/provider stigma and a number of well known structural issues likely related to racism, lack of insurance, homelessness, gentrification, and geographical access barriers.

Not mentioned as a major problem is systematic UNDERDOSING of buprenorphine in the “Age of Fentanyl” due to Medicare Advantage, Medicaid MCOs, and private insurance PBMs as related to urban patients historically disproportionately exposed to heroin —> fentanyl. Note the attached CME report from DC with fentanyl accounting for 91% (2019) –> 100% (Jan 2023) of overdose deaths. This phenomenon was documented in 2 published studies by the Howard University College of Pharmacy (2017 Case Report; 2019 Series Report).

As fentanyl and other synthetic opioids spread across the country, see how some states have responded by ending prior authorizations and raising buprenorphine dosing limits while DC officials passive-aggressively resisted and to this day remain stuck on stupid as bodies piled up …. now second only to West Virginia!

Edwin C Chapman, MD