Essien Utibe R, Sileanu Florentina E, Zhao Xinhua, Liebschutz Jane M, Thorpe Carolyn T, Good Chester B, Mor Maria K, Radomski Thomas R, Hausmann Leslie R M, Fine Michael J, Gellad Walid F
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Gen Intern Med. 2020 May;35(5):1537-1544. doi: 10.1007/s11606-020-05645-0. Epub 2020 Jan 21.
After non-fatal opioid overdoses, opioid prescribing patterns are often unchanged and the use of medications for opioid use disorder (MOUDs) remains low. Whether such prescribing differs by race/ethnicity remains unknown.
To assess the association of race/ethnicity with the prescribing of opioids and MOUDs after a non-fatal opioid overdose.
Retrospective cohort study.
Patients prescribed ≥ 1 opioid from July 1, 2010, to September 30, 2015, with a non-fatal opioid overdose in the Veterans Health Administration (VA).
Primary outcomes were the proportion of patients prescribed: (1) any opioid during the 30 days before and after overdose and (2) MOUDs within 30 days after overdose by race and ethnicity. We conducted difference-in-difference analyses using multivariable regression to assess whether the change in opioid prescribing from before to after overdose differed by race/ethnicity. We also used multivariable regression to test whether MOUD prescribing after overdose differed by race/ethnicity.
Among 16,210 patients with a non-fatal opioid overdose (81.2% were white, 14.3% black, and 4.5% Hispanic), 10,745 (66.3%) patients received an opioid prescription (67.1% white, 61.7% black, and 65.9% Hispanic; p < 0.01) before overdose. After overdose, the frequency of receiving opioids was reduced by 18.3, 16.4, and 20.6 percentage points in whites, blacks, and Hispanics, respectively, with no significant difference-in-difference in opioid prescribing by race/ethnicity (p = 0.23). After overdose, 526 (3.2%) patients received MOUDs (2.9% white, 4.6% black, and 5.5% Hispanic; p < 0.01). Blacks (adjusted OR (aOR) 1.6; 95% CI 1.2, 1.9) and Hispanics (aOR 1.8; 95% CI 1.2, 2.6) had significantly larger odds of receiving MOUDs than white patients.
In a national cohort of patients with non-fatal opioid overdose in VA, there were no racial/ethnic differences in changes in opioid prescribing after overdose. Although blacks and Hispanics were more likely than white patients to receive MOUDs in the 30 days after overdose, less than 4% of all groups received such therapy.
在非致命性阿片类药物过量使用后，阿片类药物的处方模式通常没有变化，用于阿片类药物使用障碍（MOUDs）的药物使用率仍然很低。这种处方是否因种族/族裔不同而存在差异尚不清楚。
评估非致命性阿片类药物过量使用后种族/族裔与阿片类药物及MOUDs处方之间的关联。
回顾性队列研究。
2010年7月1日至2015年9月30日期间在退伍军人健康管理局（VA）开具过≥1种阿片类药物且有非致命性阿片类药物过量使用的患者。
主要结局是按种族和族裔划分的患者比例：（1）过量使用前后30天内开具任何阿片类药物的患者比例；（2）过量使用后30天内接受MOUDs治疗的患者比例。我们使用多变量回归进行差异分析，以评估过量使用前后阿片类药物处方的变化是否因种族/族裔而异。我们还使用多变量回归来检验过量使用后MOUDs处方是否因种族/族裔而异。
在16210例非致命性阿片类药物过量使用患者中（81.2%为白人，14.3%为黑人, 4.5%为西班牙裔），10745例（66.3%）患者在过量使用前接受了阿片类药物处方（白人67.1%，黑人61.7%，西班牙裔65.9%；p<0.01）。过量使用后，白人、黑人和西班牙裔接受阿片类药物的频率分别降低了18.3、16.4和20.6个百分点，阿片类药物处方在种族/族裔方面没有显著的差异（p = 0.
