The Impact of Patient Race and Prior Misuse Behaviors on Opioid Tapering Decisions

Abstract

Given the recent opioid crisis, providers are being encouraged to taper prescription opioids for chronic pain. Racial disparities in pain treatment are well documented, but little is known about how patient race may influence provider opioid tapering decisions. Research and theory also suggest that patient race may interact with opioid use and adherence behaviors to impact provider tapering decisions. In this online study, 136 providers made opioid tapering decisions for 8 computer-simulated patients (4 Black, 4 White) with chronic pain. Text vignettes described all patients as taking prescription opioids, but half reported previous "yellow flag" misuse behaviors (e.g., early refill) and half reported medication adherence. Multilevel modeling indicated that patient history of opioid misuse increased providers' odds of changing the opioid prescription (OR=4.7, p=.03) and of endorsing the goal of discontinuing opioids (vs. maintaining at a lower dose; OR=11.0, p<.01). Patient history of opioid misuse also increased providers' odds of starting a long-acting opioid and decreasing the dose of the current opioid (vs. discontinuing opioids immediately; OR=4.2, p=.06). For providers who started a long-acting opioid, there was a significant race-by-misuse interaction on their target MED/day. For White patients, a history of opioid misuse increased providers' odds of prescribing a higher dose of the long-acting opioid (OR=3.4, p<.01), but no differences emerged for Black patients. Neither patient race nor opioid use history impacted the rate of tapering or the MED/day target for short-acting opioids. Our results indicate that the clinically-relevant information of patient opioid use history impacted provider opioid tapering decisions. Although patient race largely did not affect the tapering decisions assessed herein, prior work has found Black patients undergo more opioid-related monitoring than White patients. Future studies are needed to further understand the nuances of racial disparities in pain care during the opioid crisis. Grant support from National Institutes of Health under Award Numbers R01MD008931 and R01MD008931-05S.