Racial and ethnic disparities in opioid use for adolescents at US emergency departments

Abstract

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.

Associations of alcohol use disorder, cannabis use disorder, and nicotine dependence with concurrent opioid use disorder in U.S. adults.

“…The race/ethnicity results are consistent with prior findings that Black and Hispanic people have less opioid misuse than White people (Jones et al, 2015; Martins et al, 2017; Schuler et al, 2021; Vaughn et al, 2016). This may be in part due to racial and ethnic inequities in opioid prescribing or treatment of pain (Hoffman et al, 2016; Lee et al, 2019; Phan et al, 2021; Schuler et al, 2021). In addition, previous literature has consistently found that opioid misuse is associated with lower socioeconomic status within the United States (Dahlman et al, 2021; Han et al, 2017).…”

Accelerating Opioid Use Disorders Research by Integrating Multiple Data Modalities

“…The risk factors documented are multiple, ranging from genetic influences [10][11][12][13]; personality risk factors, such as impulsivity or the tendency toward risky behavior [14], including use of other substances; traumatic experiences, including early life adversity and family history of substance use disorders [15,16]; demographic characteristics, including exposure to opioids at young age and being male [17,18]; subjective experiences at first opioid use, such as euphoria [19]; nonmedical opioid use, including the use of opioids to get high, improve sleep, decrease anxiety [20]; medical and psychiatric comorbidities, particularly pain conditions or incidence of other substance use disorders [21]; surgical procedures, either minor or major [22,23]; higher and prolonged doses of opioids used [21]. diagnosis, prevention, and treatments.…”

Orthopaedic Diagnoses in the Black Pediatric Population

“…Access to primary care, treatment in the emergency department, and hospital treatment have all been found to have racial discrepancies, with Black children most commonly ending up with less care and poorer quality of care. 2 In the emergency department, patient race can affect analgesia, triage scores, wait times, treatments, diagnostic procedure utilization, rates of patients leaving without being seen, and patient experiences. 3…”

“…Opioid treatment of pain in adolescents has been found to favor treating non-Hispanic White patients over minorities. A study by Phan et al 2 demonstrated variability in treating pain based on race for the same diagnoses. These trends persist into adulthood, with pain in the Black population being ignored or undertreated across fields and through the end of life.…”