Flores Michael William, Sharp Amanda, Lu Frederick, Cook Benjamin Lê
Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Suite 26, Cambridge, MA, 02141, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
J Racial Ethn Health Disparities. 2024 Apr;11(2):719-729. doi: 10.1007/s40615-023-01555-z. Epub 2023 Mar 9.
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 OUD-related 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.
处方阿片类药物在过量用药死亡中仍占很大比例，并导致阿片类药物使用依赖（OUD）。疫情早期的研究表明，临床医生给种族/族裔少数群体开阿片类药物的可能性较小。由于与阿片类药物使用障碍相关的死亡在少数族裔人群中不成比例地增加，了解阿片类药物处方模式中的种族/族裔差异对于开展具有文化敏感性的缓解措施至关重要。本研究的目的是估计开具阿片类药物的患者在阿片类药物使用方面的种族/族裔差异。我们使用电子健康记录和回顾性队列研究设计，估计了多变量风险模型和广义线性模型，评估了在阿片类药物使用障碍诊断、阿片类药物处方数量、仅接受一张阿片类药物处方以及接受≥18张阿片类药物处方方面的种族/族裔差异。研究人群（N = 22201）包括成年患者（≥18岁），在32个月的研究期间，有≥3次初级保健就诊（确保与医疗保健系统有联系）、≥1张阿片类药物处方，且在首次开具阿片类药物处方之前没有阿片类药物使用障碍诊断。在未调整和调整分析中，与种族/族裔少数群体患者相比，白人患者开具的阿片类药物处方数量更多，接受≥18张阿片类药物处方的比例更高，并且在接受阿片类药物处方后被诊断为阿片类药物使用障碍的风险更大（所有组p<0.001）。尽管全国范围内阿片类药物的处方率有所下降，但我们的研究结果表明，白人患者仍然开具大量阿片类药物处方，且阿片类药物使用障碍诊断的风险更高。种族/族裔少数群体接受后续止痛药物治疗的可能性较小，这可能表明医疗质量较低。识别医疗服务提供者在种族/族裔少数群体疼痛管理中的偏见，可为寻求在充分的疼痛治疗与阿片类药物滥用/误用风险之间取得平衡的干预措施提供参考。
