Yorkgitis Brian K, Harmon Ira, Khan Azad, Webb Fern, Brat Gabriel
Department of Surgery, Indiana University School of Medicine, 540 Barnhill Drive, Indianapolis, IN, 46202, USA.
Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 W. 8th Street, Jacksonville, FL, 32209, USA.
J Racial Ethn Health Disparities. 2025 May 23. doi: 10.1007/s40615-025-02474-x.
There is wide variation in opioid prescribing practices, including opioid quantity and risk mitigation strategies (RMS). Urine drug tests (UDT) are often used as a RMS for patients prescribed opioids. There is a lack of standardized recommendations for these tests.
We aim to evaluate differences in prescribing practices, including opioid prescriptions and UDT as an RMS, among patients with multiple opioid prescriptions.
A retrospective analysis of a national outpatient database of long-term adult opioid prescriptions (≥ 3 prescriptions over a period of at least 120-days) in the United States.
Demographics, abuse history, morphine milligram equivalents (MME), UDT, and frequency were variables of interest.
96,994 met the inclusion criteria. Hispanic patients were prescribed less MME/day than non-Hispanics. Examining patients prescribed ≥ 50 MME/day, the highest rates were in American Indian/Alaskan native (8.4%) and White patients (7.5%). At least one UDT was performed in 18,203 (18.8%) patients. When categorized by race, UDTs showed that 25.8% of American Indian/Alaska native, 22.7% of Black patients, 19.2% of multiple races, 18.0% of White patients, 13.5% of Hawaiian/Pacific Islanders, and 12.7% of Asian patients underwent UDTs (p < 0.001). Among the category of ≥ 7 UDTs, Black patients (1.3%) received the most. Upon regression modeling, females (OR 0.94) and uninsured patients (OR 0.66) were less likely to undergo UDT. Among MME categories, patients prescribed 75-99 MME/day had the highest likelihood of UDT (OR 2.4). Those with opioid use disorder (OR 2.64) and tobacco use (OR 1.083) were tested more frequently. When examining race, American Indian/Alaskan natives (OR 1.36), Black patients (OR 1.36), and multiple races (OR 1.245) were more likely to undergo UDT than White patients (reference).
There is variation in opioid prescribing practices, including opioid quantity and UDT. White patients receive more opioids but less UDT than other populations. Improvements are needed to ensure universal opioid prescribing practices.
阿片类药物的处方行为存在很大差异，包括阿片类药物的用量和风险缓解策略（RMS）。尿液药物检测（UDT）经常被用作阿片类药物处方患者的风险缓解策略。对于这些检测，缺乏标准化的建议。
我们旨在评估有多个阿片类药物处方的患者在处方行为上的差异，包括阿片类药物处方以及作为风险缓解策略的尿液药物检测。
对美国一个全国性的成人长期阿片类药物门诊处方数据库（在至少120天的时间段内≥3张处方）进行回顾性分析。
人口统计学特征、滥用史、吗啡毫克当量（MME）、尿液药物检测和检测频率是感兴趣的变量。
96,994名患者符合纳入标准。西班牙裔患者每天的吗啡毫克当量处方量低于非西班牙裔患者。在每天处方量≥50 MME的患者中，美洲印第安人/阿拉斯加原住民（8.4%）和白人患者（7.5%）的比例最高。18,203名（18.8%）患者至少进行了一次尿液药物检测。按种族分类时，尿液药物检测显示，25.8%的美洲印第安人/阿拉斯加原住民、22.7%的黑人患者（19.2%的多种族患者、18.0%的白人患者、13.5%的夏威夷/太平洋岛民和12.7%的亚洲患者接受了尿液药物检测（p<0.001）。在≥7次尿液药物检测的类别中，黑人患者（1.3%）接受检测的比例最高。经回归建模，女性（OR 0.94）和未参保患者（OR 0.66）接受尿液药物检测的可能性较小。在吗啡毫克当量类别中，每天处方量为75 - 99 MME的患者接受尿液药物检测的可能性最高（OR 2.4）。患有阿片类药物使用障碍（OR 2.64）和吸烟（OR 1.083）的患者接受检测的频率更高。在按种族检查时，美洲印第安人/阿拉斯加原住民（OR 1.36）、黑人患者（OR 1.36）和多种族患者（OR 1.245）比白人患者（参照组）更有可能接受尿液药物检测。
阿片类药物的处方行为存在差异，包括阿片类药物用量和尿液药物检测。白人患者比其他人群接受的阿片类药物更多，但尿液药物检测更少。需要改进以确保普遍的阿片类药物处方行为。
