Association of Patient Race and Ethnicity With Differences in Opioid Prescribing by Primary Care Physicians for Older Adults With New Low Back Pain

Abstract

IMPORTANCE Substantial patient racial and ethnic differences in opioid prescribing have been documented, but how much of these differences were attributable to physicians prescribing opioids differently to patients of racial and ethnic minority groups is unknown, particularly during the first wave of the opioid epidemic when the dangers of opioid prescribing and use were not as well known. OBJECTIVETo examine associations of patient race and ethnicity with differences in opioid prescribing by the same primary care physician (PCP) for new low back pain episodes among older adults from 2007 to 2014. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used Medicare data of PCP office visits by Medicare beneficiaries who were 66 years or older with new low back pain. MAIN OUTCOMES AND MEASURES Prescribing of any opioid in the first year of a new low back pain episode (days 1-365) and subsequent long-term use of an opioid (prescribed for Ն180 days in days 366-730). RESULTS Among the study population of 274 771 patients (mean [SD] age, 77.1 [7.2] years; 192 105 [69.9%] women) with new low back pain, 15 285 (6%) were Asian or Pacific Islander, 16 079 (6%)were Black, 21 289 (8%) were Hispanic, and 222 118 (81%) were White, cared for by 63 494 physicians. In adjusted analysis, on average, 11.5% of the White patients (95% CI, 11.4 to 11.6) received an opioid prescription in the first year of new low back pain. The same prescribing physician was 1.5 percentage points (PP; 95% CI, −2.2 PP to −0.8 PP) less likely to prescribe an opioid if the patient was Black, 2.7 PP (95% CI, −3.5 PP to −1.8 PP) less likely if the patient was Asian or Pacific Islander, and 1.0 PP (95% CI, −1.7 PP to −0.3 PP) less likely if the patient was Hispanic. The same physician was more likely to prescribe a prescription nonsteroidal anti-inflammatory drug to a patient of a racial or ethnic minority group. White patients with new low back pain were more likely to develop subsequent long-term opioid use than patients of racial and ethnic minority groups (eg, 1.8% for White patients vs 0.5% for Hispanic patients). CONCLUSIONS AND RELEVANCEThis cross-sectional study found that from 2007 to 2014, primary care physicians prescribed opioids for new low back pain more often to White patients than to patients of racial and ethnic minority groups. These results suggest that there may have been unequal treatment of pain by physicians when less was known about the morbidity associated with opioid use.

Sociodemographic Differences in Patient-Reported Pain and Pain Management of Patients With Head and Neck Cancer in a Community Oncology Setting

“…24,[29][30][31] Given that these patients did not report significantly different amounts of pain by race, it is important to investigate whether the factors driving this variation are patient versus physician-driven or whether they are mostly system-level factors. 29,32,33 Since pain management is a complex subject especially among patients with cancer, the drivers of the racial disparities in pain prescriptions seen in the current study could be similarly convoluted. 34,35 Previous studies have suggested that patients' pain perception might differ on the basis of sociodemographic characteristics, as well as differences in patient-physician communication, decision making, health literacy, and other social determinants of health.…”

Impact of an opioid use disorder consult service on hospitalized trauma patients with opioid use disorder

“…This may indicate that the OUD consult service can provide further benefit to trauma teams via input on managing co-occurring pain and OUD while patients are hospitalized, although further research controlling for variables such as injury severity and race/ethnicity (because of the potential for provider bias) is needed. 23,24 Patients with OUD may experience withdrawal symptoms in addition to pain from injuries, and so the use and titration of methadone and buprenorphine (both for pain and withdrawal management), as well as guiding use of full-agonist opioids, may help to achieve better pain control and lessen patient withdrawal-related discomfort. 25,26 Provision of opioids for acute pain management in patients with OUD can be challenging, as these patients will likely require higher doses of opioids to maintain adequate pain control than those who are opioid naive.…”

“…While not statistically significant, a greater proportion of individuals in the consult group (59.3%) were discharged with non-MOUD full-agonist opioids than those in the nonconsult group (43.8%), even though similar proportions received opioids during hospitalization (92.6% and 90.6%, respectively). This may indicate that the OUD consult service can provide further benefit to trauma teams via input on managing co-occurring pain and OUD while patients are hospitalized, although further research controlling for variables such as injury severity and race/ethnicity (because of the potential for provider bias) is needed 23,24 . Patients with OUD may experience withdrawal symptoms in addition to pain from injuries, and so the use and titration of methadone and buprenorphine (both for pain and withdrawal management), as well as guiding use of full-agonist opioids, may help to achieve better pain control and lessen patient withdrawal-related discomfort 25,26 .…”

Patient-Provider Communication Quality, 2002–2016

“…17,21,22,39 Furthermore, studies on disparities in the provision of treatment have found that Asians experience disadvantages in certain realms of care, especially those involving subjective or affective input. For example, research finds Asian individuals to be least likely to receive prescription analgesics for pain, 40 be hospitalized for cardiovascular illnesses, 41 or receive diagnostic testing for the comorbidities of diabetes, after adjusting for need. 42 Hence, although Asians are regarded as "model minorities" and shown to be as healthy as their White counterparts on various health outcomes, 43,44 our findings, together with prior research, lend further support for the need to closely examine race-based disadvantages experienced by Asian individuals, the fastest growing population subgroup in the United States.…”