June 15, 2022 - Podcast

Episode 279 — Disparities in opioid treatment, and improving HIV research

A new study by IU researchers shows racial and ethnic disparities in the treatment of patients with opioid use disorder worsened during the COVID-19 pandemic. The study was recently published in the Journal of the American Medical Association Network Open. Health Economist Kosali Simon, a professor in the O'Neill School of Public and Environmental Affairs, says opioid use has been a silent killer during the pandemic. In 2020, there was a very large increase in the number of opioid-related deaths in the U.S., despite opioid overdoses already being one of the nation's top public health priorities prior to COVID-19. Simon and her collaborators analyzed U.S. retail pharmacy claims from May 2019 to June 2021. According to the study, there was decline in filled prescriptions for buprenorphine – a highly effective medication used to treat opioid use disorder – among Black, Hispanic and Asian patients that wasn't mirrored among white patients. Simon says that although reasons for the disparity are undetermined, the study found no immediate decreases in buprenorphine prescription fills among Medicaid patients and wider disparities between racial and ethnic groups using private insurance or Medicare. She says this finding implies that Medicaid programs may have provided a greater safety net to alleviate pandemic-related losses of income and health insurance coverage compared with other types of health insurance. The researchers say their next steps include taking a closer look at all the factors involved in the decline in medication access and the worsening of racial and ethnic disparities that already existed. In other news, an IU School of Nursing researcher is working to improve HIV research in teens and young adults, who are at highest risk for infection. Today in the U.S., 1 in 5 new HIV diagnoses occur in people ages 13 to 24. To treat this age group effectively, researchers must first learn which treatment and prevention methods work best for them. But Nurse Researcher Amy Knopf says including minors in studies can be a complicated process because, typically, researchers can't include teenagers in studies without parental consent. Knopf and her team are working to understand the impact of this requirement. The first phase of their research on the topic was a multi-site study focused on teens ages 14 to 17. They asked teens and parents how they felt about three different consent models: one in which teens could take part without notifying an adult, adult permission required, and parental permission required. Unsurprisingly, parents favored the traditional consent model. However, the response from the teens surprised Knopf and her team. Knopf says this finding differs from previous studies, in which a majority of teens indicated they were unwilling to take part in a trial that required parental consent. She is exploring possible explanations for the finding, but her prior research indicates that teens -- especially LGBTQ teens -- experience significant social benefits from participating in clinical research. Therefore, the relationship between the disclosure of sexual identity, parental engagement in the consent process, and willingness to participate in research may be more complex than researchers initially thought. Knopf is currently leading a new study with Pediatrics Professor Mary Ott that may help researchers use a method called public deliberation to deal with sensitive issues around informed consent. The researchers' hope is that finding a consent process that’s acceptable to both parents and teens could help improve recruitment and enrollment of teens at high risk for HIV in biomedical prevention trials.