Opioid Treatment Disparities Found Among Minorities

Researchers in a recent study discovered opioid treatment disparities among patients with different racial-ethnic backgrounds during emergency department (ED) visits.

Complete prior history is typically only available for ED physicians through prescription drug monitoring programs. If the information is unavailable, the physician will be unable to concretely determine whether or not the patient may have a substance use disorder, and may base treatment decisions on other factors.

ED physicians must act promptly, and may rely on subconscious factors, such as race-ethnicity when determining if they should administer or prescribe opioids, according to a study published by PLOS ONE. Previous studies established that minorities are less likely to receive opioids, but did not distinguish whether opioids were prescribed during or after ED visit.

In the current study, conditions such as back pain, abdominal pain, and dental diseases were considered non-definitive conditions, since they have no visible or diagnostic presentation. Other conditions, such as fractures and kidney stones, which have a clinical presentation, are considered definitive conditions.

Researchers analyzed data from the National Hospital Ambulatory Medical Care Survey, and included patients 18- to 65-years-old who visited the ED between 2007 and 2011.

Patients included with non-definitive conditions:

• 15,0001 patients admitted for a toothache
• 19,051 patients admitted for back pain
• 15,450 to 15,453 patients admitted for abdominal pain

Patients included with definitive conditions:

• 812 to 823 patients admitted for long-bone fractures
• 592 patients admitted for kidney stones

Researchers found that racial-ethnic minorities and younger adults were more likely to visit the ED for a non-definitive condition compared with visits for definitive conditions. They also discovered that patients with non-definite conditions were more likely to have repeatedly visited the ED within in the past year, compared with patients with definitive conditions, according to the study.

Approximately 61% of patients with abdominal pain, and 92% of patients with kidney stones, received opioids or non-opioid analgesics during or after ED visit. A majority of patients (80% to 85%) were administered an opioid in the ED, or received a prescription during discharge if they were admitted for a definitive condition, according to the study.

Only 52% to 65% of patients with non-definitive conditions received an opioid during or after ED visit. Researchers found that non-Hispanic blacks with back pain were less likely to receive an opioid prescription at discharge, or receive the treatment in the ED compared with non-Hispanic whites.

Minority patients admitted for abdominal pain had a lower chance of receiving a prescription for opioids after discharge. However, non-Hispanic blacks had a 50% decreased chance of receiving opioids in the ED compared with non-Hispanic whites.

Researchers did not find any racial-ethnic disparities among patients with toothache, long-bone fracture, and kidney stones, according to the study.

Approximately 61% of Medicaid enrollees were given opioids for toothaches in the ED, compared with 63% of uninsured patients presenting back pain. Repeated ED visits were also associated with administering opioids in the ED for abdominal pain and fractures opposed to a prescription.

Racial-ethnic disparities in opioid prescription and administration were found among patients with non-definitive conditions, but were not found among patients with definitive conditions. Researchers believe that their findings could potentially explain the reason behind the vast opioid epidemic among non-Hispanic whites, the study concluded.