Examining Racial/Ethnic Differences in Patterns of Opioid Prescribing: Results from an Urban Safety-Net Healthcare System

Abstract

Prescription opioids still account for a large proportion of overdose deaths and contribute to opioid use dependence (OUD). Studies earlier in the epidemic suggest clinicians were less likely to prescribe opioids to racial/ethnic minorities. As OUDrelated deaths have increased disproportionately amongst minority populations, it is essential to understand racial/ethnic differences in opioid prescribing patterns to inform culturally sensitive mitigation efforts. The purpose of this study is to estimate racial/ethnic differences in opioid medication use among patients prescribed opioids. Using electronic health records and a retrospective cohort study design, we estimated multivariable hazard models and generalized linear models, assessing racial/ethnic differences in OUD diagnosis, number of opioid prescriptions, receiving only one opioid prescription, and receiving ≥18 opioid prescriptions. Study population (N=22,201) consisted of adult patients (≥18years), with ≥3 primary care visits (ensuring healthcare system linkage), ≥1 opioid prescription, who did not have an OUD diagnoses prior to the first opioid prescription during the 32-month study period. Relative to racial/ethnic minority patients, White patients, in both unadjusted and adjusted analyses, had a greater number of opioid prescriptions filled, a higher proportion received ≥18 opioid prescriptions, and a greater hazard of having an OUD diagnosis subsequent to receiving an opioid prescription (all groups p<0.001). Although opioid prescribing rates have declined nationally, our findings suggest White patients still experience a high volume of opioid prescriptions and greater risk of OUD diagnosis. Racial/ethnic minorities are less likely to receive follow-up pain medications, which may signal low care quality. Identifying provider bias in pain management of racial/ethnic minorities could inform interventions seeking balance between adequate pain treatment and risk of opioid misuse/abuse.

Racial and Ethnic Disparities in Opioid Prescriptions for Patients with Abdominal Pain: Analysis of the National Ambulatory Medical Care Survey

“…Another study conducted at a safety net hospital demonstrated that White patients were in the 95th percentile of receiving opioid prescriptions compared to racial-ethnic minorities [19]. The study also noted that White patients were more likely to experience an opioid use disorder subsequent to an opioid prescription compared to minority patients.…”

Short‐acting opioid prescriptions and Workers' Compensation using the National Ambulatory Medical Care Survey

“…We also found that Black patients are at an increased risk for a short‐acting opioid prescription. Whereas, other studies have found decreased opioid prescribing in the Black patients 61,63,64 . Recently, a study of Medicare claims data found that a lower mean annual dose of opioids for Black patients compared to white 65 .…”

“…Whereas, other studies have found decreased opioid prescribing in the Black patients. 61,63,64 Recently, a study of Medicare claims data found that a lower mean annual dose of opioids for Black patients compared to white. 65 This current finding may be due to our evaluation of shortacting opioids alone or our definition of opioids, as well as our chosen study-specific variables.…”

Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD

“…We attempted to characterize cognitive behavioral therapies, but low prevalence limited further assessment by race and ethnicity. Fourth, differential OUD diagnosis by practitioners based on beneficiaries’ racial demographics may contribute to under- or overestimation of the differences in PT or chiropractic care for Black or African American and Hispanic persons, as these groups historically have been underdiagnosed for OUD . Fifth, a limitation inherent with administrative claims data is that we could not capture self-paid services for which Medicare did not provide reimbursement, leading to possible underestimation of chronic pain services among beneficiaries.…”