Nationwide, overdose fatalities continue to climb, and racial disparities in overdose rates persist. Black Americans have experienced the steepest increase in opioid-related overdoses among all groups in recent years, despite the rate of opioid use remaining higher among Whites. While the past few years have seen a significant uptick in the use of buprenorphine to treat opioid use disorder (OUD), research indicates that unequal access to the full range of evidence-based medications for opioid use disorder (MOUD) treatment persists: buprenorphine is more readily available for Whites and those with private insurance or the ability to self-pay; White communities have more access to buprenorphine, while access in  predominantly black communities may be limited to methadone.

These trends have played out in Massachusetts, and alarming disparities in data – including a 40 percent increase in overdose deaths among Black individuals despite a decrease of 3.8 percent among Whites – led the state Attorney General’s Office (AGO) to conduct outreach to local stakeholders in the BIPOC community. These leaders noted that one major barrier to treatment was an existing lack of cultural humility in OUD treatment.

Cultural humility is a treatment framework that stresses respect for individual cultural backgrounds and ongoing provider self-assessment for bias.

This came at a time when the Massachusetts AGO had settled with an Andover-based mail-order pharmacy, Injured Worker Pharmacy (IWP), for unlawful opioid prescribing and dispensing practices targeted at workers’ compensation patients in 2020. The suit followed in the wake of major multistate settlements with pharmaceutical manufacturers and is one among several in which states are pursuing lawsuits against other parties they believe culpable in advancing the opioid epidemic.

$1.5 million of Massachusetts’ $11 million settlement with IWP was dedicated to the AGO to be spent at their discretion under broad guidelines to improve care and treatment for OUD, including through grant programs. Drawing on the issues raised by stakeholders, the AGO directed $1.5 million in grant funding to community organizations to address inequities in access to OUD treatment. The state targeted resources to organizations committed to advancing public health equity, located in the communities they serve, and already using a cultural humility framework and/or the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (National CLAS Standards).

The Massachusetts grant opportunity, “Promoting Cultural Humility in Opioid Use Disorder Treatment,” was announced in October 2020. Massachusetts considered proposals from non-profits, municipalities, and quasi-public entities that demonstrated a commitment to providing culturally responsive OUD treatment for communities of color and socioeconomically diverse communities across the Commonwealth. The sixteen grantees, which were announced in February 2021, range from statewide to local and tribal initiatives, and plan to address inequities in treatment access through several distinct approaches:

• Multi-Lingual Services: Grantees plan to recruit/retain bilingual staff in clinical settings and develop their bilingual peer support/navigator workforce.
• Workforce development: All grantees plan to develop their workforces, either through training, recruitment, or retention, with a strong emphasis on peer recovery services.
• Other underserved populations: The AGO funded several grantees to address OUD in specific populations. Grantees include the programs which will use funding to target services for individuals experiencing homelessness, veterans, pregnant and parenting people, sex-workers, and individuals re-entering from incarceration settings.

The AGO notes that capacity building is a key component of Massachusetts’ long-term strategy to fight the opioid epidemic, and addressing the unmet needs of the BIPOC community must be central to this strategy. The office further emphasizes that continued conversations with the BIPOC community will inform ongoing work.

The National Academy for State Health Policy is providing this blog with the ongoing support of the Foundation for Opioid Response Efforts (FORE). The authors would also like to thank the Massachusetts Attorney General’s Office for contributing their state experiences for this blog.