Association of Patient Race and Ethnicity With Differences in Opioid Prescribing by Primary Care Physicians for Older Adults With New Low Back Pain

Dan P. Ly

doi:10.1001/jamahealthforum.2021.2333

Abstract

Substantial patient racial and ethnic differences in opioid prescribing have been documented, but how much of these differences were attributable to physicians prescribing opioids differently to patients of racial and ethnic minority groups is unknown, particularly during the first wave of the opioid epidemic when the dangers of opioid prescribing and use were not as well known. To examine associations of patient race and ethnicity with differences in opioid prescribing by the same primary care physician (PCP) for new low back pain episodes among older adults from 2007 to 2014. This cross-sectional study used Medicare data of PCP office visits by Medicare beneficiaries who were 66 years or older with new low back pain. Prescribing of any opioid in the first year of a new low back pain episode (days 1-365) and subsequent long-term use of an opioid (prescribed for ≥180 days in days 366-730). Among the study population of 274 771 patients (mean [SD] age, 77.1 [7.2] years; 192 105 [69.9%] women) with new low back pain, 15 285 (6%) were Asian or Pacific Islander, 16 079 (6%) were Black, 21 289 (8%) were Hispanic, and 222 118 (81%) were White, cared for by 63 494 physicians. In adjusted analysis, on average, 11.5% of the White patients (95% CI, 11.4 to 11.6) received an opioid prescription in the first year of new low back pain. The same prescribing physician was 1.5 percentage points (PP; 95% CI, -2.2 PP to -0.8 PP) less likely to prescribe an opioid if the patient was Black, 2.7 PP (95% CI, -3.5 PP to -1.8 PP) less likely if the patient was Asian or Pacific Islander, and 1.0 PP (95% CI, -1.7 PP to -0.3 PP) less likely if the patient was Hispanic. The same physician was more likely to prescribe a prescription nonsteroidal anti-inflammatory drug to a patient of a racial or ethnic minority group. White patients with new low back pain were more likely to develop subsequent long-term opioid use than patients of racial and ethnic minority groups (eg, 1.8% for White patients vs 0.5% for Hispanic patients). This cross-sectional study found that from 2007 to 2014, primary care physicians prescribed opioids for new low back pain more often to White patients than to patients of racial and ethnic minority groups. These results suggest that there may have been unequal treatment of pain by physicians when less was known about the morbidity associated with opioid use.

Highlights

There have been substantial racial and ethnic differences in opioid prescribing practices
On average, 11.5% of the White patients received an opioid prescription in the first year of new low back pain
The same prescribing physician was 1.5 percentage points (PP; 95% CI, −2.2 PP to −0.8 PP) less likely to prescribe an opioid if the patient was Black, 2.7 PP less likely if the patient was Asian or Pacific Islander, and 1.0 PP less likely if the patient was Hispanic

Summary

Introduction

There have been substantial racial and ethnic differences in opioid prescribing practices. These differences have been noted in emergency departments,[1,2,3,4,5] but they have been found in the outpatient setting.[6] These differences have occurred despite research suggesting that patients of racial and ethnic minority groups have the same or higher prevalence and level of pain as White patients.[7,8,9]. Whether the same physician prescribed opioids less frequently to patients of racial and ethnic minority groups than to White patients has not been explored. Such prescribing differences may suggest differential treatment or bias by physicians, during what the Centers for Disease Control and Prevention calls the first wave (through 2010) of the opioid epidemic when opioid prescribing was rapidly increasing and the dangers of opioid use were not as well known as they are today.[12,13]

Methods

Results

Discussion

Conclusion