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Study: Opioid Prescribing and Minority Patients

DENVER — Minority group patients were prescribed less potent analgesia for long-bone fractures in Northern California emergency departments (EDs), but received opioid prescriptions at the same or higher rate as white patients, researchers reported here.

All minority group patients with long-bone fracture received on average fewer total morphine milligram equivalent (MME) units than white patients in EDs of a large healthcare delivery system, according to a retrospective study by Alice Pressman, PhD, of Sutter Health in Walnut Creek, California, and colleagues presented at the American Academy of Pain Medicine meeting.

This pattern may represent an overprescribing of opioids to non-Hispanic whites and may reflect implicit biases about race and ethnicity, they concluded.

Recent research has suggested that racial biases in opioid prescribing may have shaped the opioid crisis, demonstrating that low-income white patients in California were more likely to receive opioid prescriptions and die from overdoses than other groups. Other studies have indicated that pain may be undertreated in both adult and pediatric minority populations throughout the U.S.

Evidence about opioid prescribing for long-bone fractures is mixed: several studies have shown that minority group patients with long-bone fractures are less likely to receive opioids in EDs than white patients, while other analyses have not found this relationship.

For this study, Pressman’s group examined Sutter Health electronic health records to identify all ED discharges for long-bone fractures in 2016, evaluating accompanying prescription orders, comorbidities, and demographic data. They included age, sex, ambulatory status, acuity level, time of day, comorbidities, multiple fractures, insurance, prior opioid prescriptions, provider type, provider sex, and other covariates in their analysis.

The researchers identified 5,719 adult patients with long-bone fracture who were treated by 369 ED providers in that period. Most fractures involved the radius/ulna (43%), followed by the fibula/tibia (29%), the humerus (22%), and the femur (6%).

Overall, 66% of patients received an opioid prescription at discharge. The average total MME units prescribed were 127.5.

Compared with non-Hispanic white patients, the only difference in the likelihood of receiving an opioid at discharge was that Hispanic patients had greater odds (OR 1.20, 95% CI 1.00-1.44; P<0.05). A total of 71% of Hispanic patients received opioids, compared with 64% of white patients, 66% of African-American patients, and 65% of Asian patients.

Among patients who received opioids, however, all minority group patients received on average fewer total MME units than white patients (P<0.05). White patients received 132.3 MME units; Asian patients received 109.4, African-American patients received 118.6, and Hispanic patients received 122.6.

“The act of prescribing was similar across races, but the amount prescribed was different,” Pressman said. “Patients of minority race received less potent opioids on average than non-Hispanic white patients.”

“In order to address the opioid epidemic, it is vital that we understand current prescribing practices, and whether there exist implicit biases among providers who prescribe these drugs,” Pressman told MedPage Today.

This analysis was retrospective and had the limitations of an observational study, including unknown confounders. Race and ethnicity were self-identified. All patients were seen a single healthcare delivery system that includes 24 acute care hospitals in Northern California, and results may not apply to other healthcare systems or other parts of the country.

Pressman disclosed no relevant relationships with industry.