7 Ways to Close the Racial Gap in Addiction Treatment, BMC Study Finds

Provisional data released in August showed that the national overdose death rate declined by 17% over the last 12 months, a downward trend since 2020. However, overdose deaths among Black people have continued to rise in the same span. Data collected by Boston Medical Center (BMC) revealed that Black patients are less likely to receive follow-up addiction treatment after they are seen for a substance-related crisis in the Emergency Department. That is why, in May 2021, a team of researchers led by Miriam Komaromy, MD, medical director of Grayken Center for Addiction, sought to understand the root causes of the disparities in addiction treatment outcomes for Black patients in an effort to seek effective and equitable treatment for all patients.  

Komaromy and her team recently published their findings from that study, “Embracing anti-racism: Co-creating recommendations with Black people for how addiction treatment needs to change” in Social Science and Medicine. Study authors Komaromy;  Daneiris Heredia-Perez, senior research project manager; and Phillip Reason, co-principal investigator, spoke with HealthCity about their work undertaking this research, the findings, their takeaways, and what comes next. The conversation sheds light on the role of community in research and calls upon additional anti-racist research to be conducted in the addiction treatment space. 

HealthCity: In what ways does this research build upon prior work in the addiction treatment space? 

Miriam Komaromy, MD: Upon initial investigation, the team discovered a noticeable gap in academic work conducted on the anti-racism in the substance use disorder (SUD) space. Racial disparities and inequities appear in all parts of clinical care, and they have certainly been documented in addiction treatment, too. However, we don’t see much research that goes beyond that to identify actual solutions.

What makes this study unique is that we seek to understand the steps that we need to take in order to address inequities in addiction care. Our efforts are geared towards making addiction treatment more appealing, effective, and equitable to Black patients with SUD. 

HC: What were the key areas of investigation and why did you select them? 

MK: We identified four key areas to assess factors that are barriers or facilitators of effective treatment.  For patients, we wanted to understand what barriers impeded access to treatment. For providers, we wanted to understand the elements of treatment programs that discouraged participation and/or completion. And, finally, on the systems level, we wanted to understand how structures and policies dissuade or discourage participation within Black patient populations.  

We also designated trauma as its own discussion. Notably, trauma experiences related to social identity are not currently recognized in clinical criteria. Our work challenges this notion and implores others to consider the role of race-based trauma in addiction treatment.  

HC: In what ways did the community enhance your research? 

Phillip Reason: Community was at the heart of how this research was conducted. Over the course of the study, we assembled six focus groups for one-time, anonymous events. The focus groups comprised participants who identify as Black with lived experiences of SUD in the Boston community.  

“Community was at the heart of how this research was conducted.”

Phillip reason, co-principal investigator

The foundation of our approach was to be guided by, in partnership with, and in close proximity to the focus groups. The research team was intentional about limiting the traditional power dynamics that are typically present in the research space. We went out into the community instead of having the community come to us. We convened at local spots and went by first names. By doing something as simple as dropping our titles, we were able to create an inviting dynamic that encouraged meaningful conversation and participation. A group member said, “I have been wanting to share my experience. I am glad you asked, I have been waiting for a time and place to talk about this.” 

HC: From the focus groups, the Council of Experts on Patient Experience was born. Can you explain the role of the council and how it has evolved to have lasting impact on research and systems beyond the study? 

Daneiris Heredia-Perez: In recognition of the valuable contributions brought forth by the focus group participants, the research team created the Council of Experts on Patient Experience (CEPE). The council is an extension of the focus group, comprising focus group members who expressed desire to have a continuous role throughout the research process. 

Our study team’s function was to document what the focus groups told us and to translate those findings into specific action items. We then took those findings and brought them back to the group to ensure an accurate representation of their experiences. At every juncture of the research, the CEPE provided invaluable feedback to the team. Our recommendations do not just stem from academics; they are also infused with the lived experiences of people with SUD. It is from patients, for patients. 

HC: Your research resulted in seven action items to make addiction treatment more effective and attractive for Black patients. In what ways can health professionals implement your action items in ways that work for their specific care environment? 

MK: It is important to note that our findings are not a protocol or a prescription. They are a generalized description of what needs to change in existing SUD treatment programs and our work proposes action items on how to do so. We hope that practitioners and medical professionals can extract lessons and truths from our findings while maintaining that not all experiences and settings are the same. Intersectionality exists within everyone, and all aspects of our identity have a unique impact on the individual level. What bridges our conclusions that are specific to black patient populations, to other patient populations of color, is the impact of systemic and historic racism within our healthcare systems. 

HC: What stands out to you when reflecting on the years dedicated to this work? 

PR: Throughout the process I had the pleasure of seeing the evolution of our focus group members, which I believe was driven through our approach of shared understanding, compassion, and empowerment. 

I can recall one person in particular who entered the process understandably reserved. This person was eager to share contributions but was hesitant about doing so in front of an audience. During the group conversation, this person would whisper to me what they wanted to share with the larger group. I would listen and then share out. Throughout time, this person became increasingly confident in sharing their contributions. 

“Our recommendations do not just stem from academics; they are also infused with the lived experiences of people with SUD. It is from patients, for patients.”

Daneiris Heredia-Perez, senior research project manager, grayken center for addiction

Flash-forward, and this same person presented in front of 80 people at one of the biggest addiction conferences, AMERSA 2024. The culture the research team was able to foster of shared value and importance between the team and the participants is something I am really proud to have been a part of. I have found that to be a defining and unique characteristic of this particular study, and I implore other researchers to take our lead on community-based approaches to research.  

HC: What is next for this research? 

DHP: The next step is to collaborate with residential addiction treatment programs to pilot the recommendations of the study and assess the impact on the patient experience and clinical outcomes. We are looking to understand all aspects of the treatment program for all of those involved in delivering care. 

We will continue to work within our own system to improve clinical outcomes for Black patients and other marginalized patient populations with SUD. A residential addiction treatment program we worked with in the most recent phase of our work has already implemented a number of action items to re-imagine care. Throughout the process we will continue to share our work with policymakers and other healthcare institutions and organizations to reform addiction care to reflect the needs of all patients.

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This interview has been edited and condensed for clarity and length.