Boston Study Finds Discrimination Against Patients with Substance Use Disorder

A recent study found that 29% of private post-acute care facilities in Massachusetts rejected admission referrals for hospitalized individuals with opioid use disorder (OUD), highlighting a need to address discrimination and stigmas against OUD.¹

The study, led by investigators at Boston Medical Center’s (BMC) Grayken Center for Addiction, concluded that the private care facilities demonstrated repeated and explicit discrimination against these patients based on their diagnosis or medication treatment status.¹

Published in the Journal of Addiction Medicine, data revealed that 15.1% of patient rejections were based on an individual’s diagnosis with substance abuse disorder (SUD), or because they were being treated for OUD with buprenorphine or methadone, and were consequently deemed discriminatory, as well as in violation of the Americans with Disabilities Act.¹

Investigators linked electronic health record data (EHR), including referrals, that had evidence of OUD to private Massachusetts post-acute medical care facilities Boston Medical Center in 2018 with clinical data.1,2Mechanisms to support OUD instance in referrals included implementation of ICD-10 diagnosis codes and opioid agonist therapy (OAT) receipts.²

Results from the study showed 219 OUD-related hospitalizations leading to 1648 referrals to 285 facilities in the region, where 81.8%, or 1348, referrals were rejected by private post-acute care facilities.²

Of the confirmed discriminatory rejections, 105 were rejected due to the patient’s use of buprenorphine or methadone, and 98 were rejected due to the patient’s substance use disorder (SUD) diagnosis.²

Despite legal settlements in 2018 and 2019 among 2 different private post-acute care facilities and the United States Attorney’s office for the District of Massachusetts as a result of discriminatory practices, study investigators reported no improvements in rates of discriminatory rejections within these facilities.²

Barring individuals who are taking medication to treat OUD is an apparent display of discrimination and stigmatizing against SUD, according to the investigators, and health care facilities should ensure that these patients can access necessary medical care.¹

Beyond post-acute care rejection, the study also found that only 2 of 3 patients with SUD referred to these facilities end up being discharged to one, including to wound care, physical and/or occupational therapy, and medical care for other underlying conditions.¹

"This data demonstrates a troubling pattern of explicit discrimination aimed at patients with substance use disorders who need post-acute medical care, despite the guidance from the Massachusetts Department of Public Health and being in violation of federal law," said Simeon Kimmel, MD, MA, addiction medicine and infectious diseases specialist at the Grayken Center and corresponding author of the study.¹

Investigators concluded that enforcement of anti-discrimination laws require revising in order to address stigmas against OUD and to ensure that patients with OUD do not experience barriers to necessary medical care.²

References:

1. Patients with substance use disorder discriminated against by post-acute care facilities. News Release. EurekAlert; July 16, 2020. Accessed July 22, 2020. https://www.eurekalert.org/pub_releases/2020-07/bmc-pws071620.php.
2. Kimmel SD, Rosenmoss S, Bearnot B, et al. Rejection of Patients With Opioid Use Disorder Referred for Post-acute Medical Care Before and After an Anti-discrimination Settlement in Massachusetts. Journal of Addiction Medicine. 2020; doi: 10.1097/ADM.0000000000000693.