Pandemic MAT Flexibilities Widen VA Treatment Disparities

When COVID-19 hit, federal regulators relaxed the rules around the two most effective medications for treating opioid use disorder.

Methadone clinics were allowed to hand out take-home doses. Starting buprenorphine was also made easier. The goal of these rule changes was to keep people in medication assisted treatment when showing up daily was no longer safe.

An analysis of Veterans Health Administration records shows that the benefits of those flexibilities flowed unevenly. Researchers at the University of Washington and VA Puget Sound Health Care System tracked more than 110,000 veterans diagnosed with opioid use disorder across 48 consecutive monthly cohorts from March 2018 through February 2022.

Their findings show that while treatment access expanded overall, racial and ethnic gaps in who received each medication did not close. In several measures they widened.

Where the Gaps Opened

The system looked equitable at the start of the study window. In March 2018, 27.8% of non-Hispanic white veterans with opioid use disorder received medication for OUD. It was nearly identical to the 27.3% rate for non-Hispanic Black veterans.

By February 2022, white veterans had climbed to 35.0% while Black veterans reached only 29.3%. The medication-specific numbers explain the split.

Buprenorphine, which can be prescribed in ordinary medical visits and taken at home, rose for white veterans from 27.9% to 29.8%.

For Black veterans it barely moved, from 13.9% to 15.5%. For Black Hispanic veterans, it only moved from 11.6% to 15.1%.

White veterans were roughly twice as likely as Black veterans to receive buprenorphine at both the start and the end of the period. Methadone told the opposite story.

Receipt declined for every group after the pandemic began. Black veterans remained far more likely to be on it.

Non-Hispanic Black veterans receiving methadone fell from 17.4% to 14.4%, while non-Hispanic white veterans fell only from 6.6% to 5.5%.

Methadone is a life-saving medication, but it is tied to daily clinic visits under federal rules. Buprenorphine fits around a job, a family and a private life.

The data describe a persistent hierarchy in which Black veterans end up with the medication that demands the most from their daily lives. White veterans end up with the one that asks the least.

The study was designed to be descriptive rather than causal. It does not name the mechanisms behind the gaps.

But its conclusion is pointed. Improving equity may require targeted efforts to reduce barriers to both medications, rather than assuming broad flexibilities will lift all boats.

What This Means for Medication Assisted Treatment Access

The study carries two practical lessons. The first lesson is that the medication you are offered matters as much as whether you are offered one at all.

The second lesson is that flexibility in policy does not guarantee equity in delivery. The researchers also broke Hispanic patients into subgroups, revealing that Black Hispanic veterans ended the study with the lowest medication receipt of any group examined, a disparity hidden when all Hispanic patients are counted together.

VA addiction treatment options deserve a direct conversation with your care team about which medication fits your life.

Detox as the Entry Point to Equitable Care

None of these medications works well if people cannot first stabilize. Medical detox remains the front door for many people entering recovery.

The VA is the largest integrated health system in the country. If gaps can persist there, they can persist anywhere. The lesson of this research is to treat access as something that must be checked.

Ask about buprenorphine, ask about methadone take-homes and ask what the path looks like after detox. Those questions are how the hierarchy the study documented starts to flatten.

Search Detox.com’s directory to locate a detox center in your area. You can call 800-996-6135Sponsored to speak with a treatment advisor and learn more about your options.