Sally Satel of the American Enterprise Institute explores the impact of identity politics on healthcare outcomes.
The job of medicine is to promote patients’ health: that is doctors’ contribution to social justice.
Methadone has been used for decades as treatment for heroin addiction. The long-acting synthetic opioid is given daily to block withdrawal symptoms and drug craving. Patients attend a methadone clinic every day to get their dose and, as they demonstrate reliability and growing commitment to the treatment program can earn increasing numbers of “take home” doses, up to a full month. The staff balance the earned freedom with the risk that a patient might sell their methadone or combine it with other drugs.
During COVID-19, federal government issued a new guidance for methadone clinics, in an effort to decrease infection risk. Whereas before the pandemic, even patients in good standing had to wait months before they could get a single “take-home” bottle per week, the new rule allowed “stable” patients, as the guidance called them, an entire month of take-home doses within a matter of weeks.
A research team decided to examine the distribution of take-home privileges by race. As they reported recently in JAMA Network Open, Black methadone patients on Medicare were less likely to receive take homes than white and Hispanic patients. The authors speculated upon possible reasons why this might have been the case: not all clinics necessarily adopted the new, more lenient policy, some patients may have preferred to attend daily, perhaps there was racial and ethnic bias on the part of the staff, and, critically, it was unlikely that all patients were deemed stable enough for take-homes.
Yet absent any clues about the relative contribution of these potential variables to the outcome—the racial distribution of take-homes—the authors concluded that, “Our findings highlight the imperative to reduce inequities in [Opioid Use Disorder] treatment.”
