Fewer doctors withhold opioids from black patients

Fewer doctors are discriminating against black patients when prescribing narcotics for pain relief, research finds.

Racial disparities in pain management are well-documented, with doctors historically more willing to prescribe opioids to whites than to other racial and ethnic groups.

In light of new national policies to improve prescribing practices, researchers wanted to know whether racial and ethnic disparities in pain management have changed in recent years—particularly if any shift in opioid prescribing was associated with changes in the use of other pain medications.

“To our knowledge, this is the first evidence of a potential narrowing of the divide in opioid prescribing by race and ethnicity.”

To do this, they looked at prescription data from people who reported moderate to severe non-cancer pain in the Medical Expenditure Panel Survey from 2000-2015. Researchers identified common opiates and three classes of non-opiate pain medications: nonsteroidal anti-inflammatory drugs, muscle relaxants, and cox-2 inhibitors.

“To our knowledge, this is the first evidence of a potential narrowing of the divide in opioid prescribing by race and ethnicity,” says Matthew Davis, assistant professor of nursing at the University of Michigan and lead author of the paper in the American Journal of Health.

Opioid use and the associated risks are often perceived to be an issue primarily among white Americans, says first author Jordan Harrison, a postdoctoral fellow at the University of Pennsylvania who received her doctorate from the University of Michigan’s School of Nursing. The downside of the new findings is that blacks now face increased risk of addiction through exposure to prescription narcotics.

“Our findings suggest, however, a persistent reliance on opioids across all racial/ethnic groups. More work is needed to examine the complex interaction of patient and provider factors that influence opioid prescribing practices.”

Also worth noting is the use of opioids relative to nonsteroidal anti-inflammatory drugs among blacks and whites–use of NSAIDS is higher among blacks–which hints at a preference difference in prescribing NSAIDS, Davis says.

“It’s not that patients in pain aren’t being treated, it’s the differences in the choice of what is prescribed.”

Can this new painkiller evade the flaws of opioids?

The study did not examine why more blacks are now using prescription opioids, but the change could partially reflect gains in public insurance coverage since 2010. However, all racial and ethnic groups experienced similar declines in private health insurance coverage.

After adjusting for age and sex, prescription opioid use increased across all racial and ethnic groups over the study period, with the greatest increases (78 percent) among whites. Hispanics appear to use opioids less than other groups, with about 15 percent using opioids over time. This is about the same as the number of Hispanics getting NSAIDS.

Higher risk of death with opioids than other painkillers

Overall, 30-35 percent of American adults who have pain received a pain medication of some kind over the 15-year period, regardless of ethnicity.

As the number of prescriptions for opiates increased across the board, the use of NSAIDS (Motrin, Aleve) also increased overall. Use of muscle relaxers and Cox-2 inhibitors (Celebrex, Vioxx) decreased.

Source: University of Michigan