Key Points Question How has opioid use in pediatric patients changed over the past 10 years, and what factors are associated with differences in opioid use? Findings A cross-sectional study of 69 152 emergency department visits found that opioid prescribing rates decreased between 2006 to 2010 (8.23%) and 2011 to 2015 (6.30%). Region, race, age, and payment method were associated with differences in opioid prescribing. Meaning Opioid rates have decreased in recent years but inconsistencies in prescribing continue, suggesting the need for further research.

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Disclosures: Donald Morisky receives a royalty for use of the copyrighted and trademarked MMAS-8. Funding: Jon Schommer received The PetersInstitute in Pharmacy Practice Innovation, Endowed Chair Award, which was used to fund this project. Findings: Overall adherence rates did not differ significantly between rural and urban adults with average adherence based on MMAS-8 scores of 5.58 and 5.64, respectively (P = .253). Age, income, education, male sex, and white race/ethnicity were associated with higher adherence rates. While the overall adherence rates between urban and rural adults were not significantly different, the factors that influenced adherence varied between age-specific population density groupings. Conclusion:These analyses suggest that there is no significant difference in adherence between rural and urban populations; however, the factors contributing to medication adherence may vary based on age and population density. Future adherence intervention methods should be designed with consideration for these individualized factors.Key words access to care, health care access, medication adherence, medication use, pharmacy.Medication nonadherence is considered one of the greatest modifiable health risks to exist in the United States. Nearly half of all Americans who are prescribed a prescription medication are nonadherent to it. 1 The presence of nonadherence to prescription medications causes poor health-related outcomes. Nonadherence has been shown to increase the likelihood of disease progression, lead to higher utilization of health care services, increase the cost of care, and cause higher mortality rates. 2-9The cause of nonadherence is complex and there are many factors that have been linked to increasing rates of nonadherence. These include factors related to the cost of the medications, socioeconomic status, and convenience. [10][11][12][13][14][15] With increasing rates of poverty

Background Racial/ethnic disparities in the use of opioids to treat pain disorders have been previously reported in the emergency department (ED). Further research is needed to better evaluate the impact race/ethnicity may have on the use of opioids in adolescents for the management of pain disorders in the ED. Methods This was a cross-sectional study using data from the National Hospital Ambulatory Medical Care Survey from 2006 to 2016. Multivariate models were used to evaluate the role of race/ethnicity in the receipt of opioid agonists while in the ED. All ED visits with patients aged 11–21 years old were analyzed. Races/ethnicities were stratified as non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. In addition to race, statistical analysis included the following covariates: pain score, pain diagnosis, age, region, sex, and payment method. Results There was a weighted total of 189,256,419 ED visits. Those visits involved 109,826,315 (58%) non-Hispanic Whites, 46,314,977 (24%) non-Hispanic Blacks, and 33,115,127 (18%) Hispanics, with 21.6% (95% CI, 21.1%-22.1), 15.2% (95% CI, 14.6–15.9%), and 17.4% (95% CI, 16.5–18.2%) of those visits reporting use of opioids, respectively. Regardless of age, sex, and region, non-Hispanic Whites received opioids at a higher rate than non-Hispanic Blacks and Hispanics. Based on diagnosis, non-Hispanic Whites received opioids at a higher rate in multiple pain diagnoses. Additionally, non-Hispanic Blacks and Hispanics were less likely to receive an opioid when reporting moderate pain (aOR = 0.738, 95% CI 0.601–0.906, aOR = 0.739, 95% CI 0.578–0.945, respectively) and severe pain (aOR = 0.580, 95% CI 0.500–0.672, aOR = 0.807, 95% CI 0.685–0.951, respectively) compared to non-Hispanic Whites. Conclusions Differences in the receipt of opioid agonists in EDs among the races/ethnicities exist, with more non-Hispanic Whites receiving opioids than their minority counterparts. Non-Hispanic Black women may be an especially marginalized population. Further investigation into sex-based and regional differences are needed.

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