Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA.
Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA.
Subst Abus. 2020;41(2):232-244. doi: 10.1080/08897077.2019.1686721. Epub 2019 Nov 13.
: Research indicates U.S. racial and ethnic minority patients are prescribed opioids for pain less often than non-Hispanic Whites. Racial inequities are strongest for pain conditions with uncertain prognosis (e.g., chronic pain syndrome) compared to acute pain with defined duration (e.g., fractures). As naloxone, an opioid overdose reversal drug, becomes more popular among prescribers in clinical contexts, it is unclear whether racial inequities also extend to naloxone prescriptions. : Patients diagnosed with bone fracture ( = 551,103) or chronic pain syndrome [CPS] ( = 173,341) were identified using ICD-9 and ICD-10 codes in electronic health records from the Health Facts® Database. Logistic regressions were used to determine whether the likelihood of receiving a prescription for opioids or a co-prescription for opioids and naloxone differ by patient race/ethnicity, which included African American, Native American, Non-Hispanic White, Asian/Pacific Islander, Hispanic, and "other" categories. : Multiple logistic regressions show naloxone prescriptions do not consistently mirror trends in opioid prescriptions when broken down by patient race/ethnicity and diagnosis. Patients of color with bone fracture or CPS are largely less likely to receive prescriptions for outpatient opioid analgesics than their non-Hispanic White counterparts. Among bone fracture patients prescribed opioids, African Americans and patients of "other" race/ethnicity are also significantly less likely to receive naloxone prescriptions. However, Native American and Hispanic CPS patients prescribed opioids are more likely to get naloxone prescriptions despite being less likely to get opioid prescriptions. And while Native American and Asian/Pacific Islander fracture patients and "other" race/ethnicity CPS patients are less likely to receive an opioid prescription than non-Hispanic Whites, there is no difference from non-Hispanic Whites in their likelihood of receiving a naloxone prescription. : Among patients prescribed opioids, naloxone prescriptions vary by patient race/ethnicity and by health condition, indicating the need for efforts to assure equitable diffusion of this harm reduction intervention.
研究表明，美国的少数族裔患者接受阿片类药物治疗疼痛的情况不如非西班牙裔白人常见。与具有明确持续时间的急性疼痛（例如骨折）相比，对于预后不确定的疼痛状况（例如慢性疼痛综合征），种族差异最大。随着纳洛酮（一种阿片类药物过量逆转药物）在临床环境中越来越受到处方者的欢迎，目前尚不清楚种族差异是否也会扩展到纳洛酮处方。
使用健康事实数据库中的电子健康记录中的 ICD-9 和 ICD-10 代码，确定诊断为骨折（=551,103）或慢性疼痛综合征[CPS]（=173,341）的患者。使用逻辑回归确定接受阿片类药物处方或阿片类药物和纳洛酮联合处方的可能性是否因患者的种族/族裔而异，包括非裔美国人、美洲原住民、非西班牙裔白人、亚洲/太平洋岛民、西班牙裔和“其他”类别。
多项逻辑回归表明，当按患者种族/族裔和诊断细分时，纳洛酮处方并不总是反映阿片类药物处方的趋势。患有骨折或 CPS 的有色人种患者，与非西班牙裔白人相比，接受门诊阿片类镇痛药处方的可能性要低得多。在接受阿片类药物处方的骨折患者中，非裔美国人和其他种族/族裔的患者也明显不太可能接受纳洛酮处方。然而，尽管接受阿片类药物处方的美洲原住民和西班牙裔 CPS 患者不太可能获得阿片类药物处方，但他们获得纳洛酮处方的可能性却更高。虽然接受阿片类药物处方的美洲原住民和亚洲/太平洋岛民骨折患者和 CPS 的“其他”种族/族裔患者比非西班牙裔白人更不可能获得阿片类药物处方，但他们获得纳洛酮处方的可能性与非西班牙裔白人没有差异。
在接受阿片类药物处方的患者中，纳洛酮处方因患者的种族/族裔和健康状况而异，这表明需要努力确保这种减少伤害干预措施的公平推广。
