Both Race and Insurance Type Independently Predict the Selection of Oral Opioids Prescribed to Cancer Outpatients

Abstract

a b s t r a c tBackground: Previous research suggests that racial disparities in patients' reported analgesic adverse effects are partially mediated by the type of opioid prescribed to African Americans despite the presence of certain comorbidities, such as renal disease. Aims: We aimed to identify independent predictors of the type of opioid prescribed to cancer outpatients and determine if race and chronic kidney disease independently predict prescription type, adjusting for relevant sociodemographic and clinical confounders. Design: We conducted a secondary analysis of a 3-month observational study. Setting: Outpatient oncology clinics of an academic medical center. Participants/Subjects: Patients were older than 18 years of age, self-identified as African American or White, and had an analgesic prescription for cancer pain. Methods: Cancer patients (N ¼ 241) were recruited from outpatient oncology clinics within a large mid-Atlantic healthcare system. Results: Consistent with published literature, most patients (75.5%) were prescribed either morphine or oxycodone preparations as oral opioid therapy for cancer pain. When compared with Whites, African Americans were significantly more likely to be prescribed morphine (33% vs 14%) and less likely to be prescribed oxycodone (38% vs 64%) (p < .001). The estimated odds for African Americans to receive morphine were 2.573 times that for Whites (95% confidence interval 1.077-6.134) after controlling for insurance type, income, and pain levels. In addition, the presence of private health insurance was negatively associated with the prescription of morphine and positively associated with prescription of oxycodone in separate multivariable models. The presence of chronic kidney disease did not predict type of analgesic prescribed. Conclusions: Both race and insurance type independently predict type of opioid selection for cancer outpatients. Larger clinical studies are needed to fully understand the sources and clinical consequences of racial differences in opioid selection for cancer pain.

Impact of Cannabis Use on Least Pain Scores Among African American and White Patients with Cancer Pain: A Moderation Analysis

“…This finding is consistent with a large body of evidence demonstrating that African Americans experience inadequate pain relief, relative to White patients. 4 , 7 , 26 , 27 These relatively high “least pain” scores are also particularly striking considering that 60% of the sample were prescribed over 50 MME/day of opioids. Adding to the literature, our data suggest that this disparity is significantly reduced among patients who report cannabis use.…”

Reductions and pronounced regional differences in morphine distribution in the United States

“…We do not believe that there are four-fold biological nociceptive differences between the residents of Tennessee relative to those in an adjacent state (e.g., Kentucky) that receive much less morphine. Future research should continue to explore the provider (22) or patient attitudes (23), insurance company (24) or pharmacy policies (25) that would account for this sizable variation. This might aid in the identification of practices that are incongruent with evidence-based medicine and warrant improved efforts to balance the benefits of morphine (e.g.…”

Editorial: Chronic Pain and Health Disparities in Older Adults With Complex Needs

“…These disparities are present in all health care settings (i.e., primary care, the emergency room, post-operative, and palliative) across all types of pain (i.e., cancer, neuropathic, acute, chronic) (5-9). Despite this overwhelming evidence, little progress has occurred because barriers to equitable healthcare exist at multiple levels from the individual level to healthcare providers, healthcare systems, and local governments (1,3,(10)(11)(12)(13)(14)(15)(16)(17). A person with pain may not believe that non-pharmacologic therapies such as behavioral therapy will work and thus may not follow up or engage in these proven treatments, especially if there is a share of cost (19)(20)(21)23).…”