Hu Ju-Chen, Chakraborty Promi, Zhang Hao, Portenoy Russell, Rosa William E, Zhang Yiye, Reid M Carrington, Tamimi Rulla M, Zhang Fang, Bruera Eduardo, Paice Judith A, Bao Yuhua
Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States.
Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY, United States.
Pain. 2025 Jan 21;166(7):1653-1661. doi: 10.1097/j.pain.0000000000003511.
Rapid declines in opioid analgesics dispensed in American communities since 2011 raise concerns about inadequate access to effective pain management among patients for whom opioid therapies are appropriate, especially for those living in racial/ethnic minority and socioeconomically deprived communities. Using 2011 to 2021 national data from the Automated Reports and Consolidated Ordering System and generalized linear models, this study examined quarterly per capita distribution of oxycodone, hydrocodone, and morphine (in oral morphine milligram equivalents [MMEs]) by communities' racial/ethnic and socioeconomic profiles. Communities (defined by 3-digit-zip codes areas) were classified as "majority White" (≥50% self-reported non-Hispanic White population) vs "majority non-White." Community socioeconomic deprivation was measured by quartiles of population-weighted Social Deprivation Index. Overall, majority non-White communities had at least 40% lower mean adjusted per capita distribution than majority White communities across all levels of socioeconomic deprivation. Among the least deprived communities, the adjusted mean per capita distribution was 46.0 (95% confidence interval [CI], 40.0-52.0) for majority non-White vs 82.8 (95% CI, 78.5-87.1) MMEs for majority White communities. Among the most deprived communities, the distribution was 78.0 (95% CI, 70.8-85.1) for majority non-White vs 134.4 (95% CI, 125.4-143.4) MMEs for majority White communities. The lower distribution in majority non-White communities was statistically significant across all socioeconomic deprivation levels and over all study years. Availability of commonly prescribed opioid analgesics was substantially lower in majority non-White communities than in majority White communities across all levels of socioeconomic deprivation. Policies governing opioid analgesic availability warrant careful consideration and potential adjustments.
自2011年以来，美国社区阿片类镇痛药的配药量迅速下降，这引发了人们对适合使用阿片类药物治疗的患者无法充分获得有效疼痛管理的担忧，尤其是那些生活在种族/族裔少数群体和社会经济贫困社区的患者。本研究利用2011年至2021年来自自动报告和综合订购系统的全国数据以及广义线性模型，按社区的种族/族裔和社会经济特征，对羟考酮、氢可酮和吗啡（以口服吗啡毫克当量[MMEs]计）的季度人均配药量进行了研究。社区（由三位邮政编码区域定义）被分为“白人占多数”（自我报告的非西班牙裔白人人口≥50%）和“非白人占多数”。社区社会经济贫困程度通过人口加权社会剥夺指数的四分位数来衡量。总体而言，在所有社会经济贫困水平上，非白人占多数的社区平均调整后的人均配药量比白人占多数的社区至少低40%。在最不贫困的社区中，非白人占多数的社区调整后的人均配药量为46.0（95%置信区间[CI]，40.0 - 52.0）MMEs，而白人占多数的社区为82.8（95%CI，78.5 - 87.1）MMEs。在最贫困的社区中，非白人占多数的社区配药量为78.0（95%CI，70.8 - 85.1）MMEs，而白人占多数的社区为134.4（95%CI，125.4 - 143.4）MMEs。在所有社会经济贫困水平和整个研究年份中，非白人占多数的社区较低的配药量具有统计学意义。在所有社会经济贫困水平上，非白人占多数的社区常用阿片类镇痛药的可获得性显著低于白人占多数的社区。有关阿片类镇痛药可获得性的政策值得仔细考虑并可能进行调整。
