Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse

• Published in: PloS one Vol. 11; no. 8; p. e0159224
• Main Authors: Singhal, Astha, Tien, Yu-Yu, Hsia, Renee Y.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.08.2016; Public Library of Science (PLoS)
• Subjects: Abdomen; Adolescent; Adult; Adults; Aged; Ambulatory care; Analgesics; Analgesics, Opioid - therapeutic use; Back pain; Biology and Life Sciences; Black people; Continental Population Groups; Cues; Cultural differences; Departments; Discharge; Disease control; Dispensing; Drug abuse; Drug addiction; Drug Utilization - statistics & numerical data; Drug Utilization - trends; Drug-Seeking Behavior; Emergencies; Emergency medical care; Emergency medical services; Emergency Service, Hospital - trends; Emergency Service, Hospital - utilization; Emergency services; Engineering and Technology; Ethnic Groups - classification; Ethnic Groups - statistics & numerical data; Ethnicity; Family physicians; Female; Fractures; Geriatrics; Health aspects; Health Care Surveys; Healthcare Disparities - statistics & numerical data; Healthcare Disparities - trends; Hispanic people; Hospital emergency services; Hospitals; Humans; Kidney stones; Kidneys; Long bone; Male; Medical personnel; Medicine and Health Sciences; Middle Aged; Minority & ethnic groups; Mortality; Narcotics; Nephrolithiasis; Older people; Opioids; Pain; Pain - drug therapy; Pain - ethnology; Pain - etiology; Patients; People and Places; Pharmacy; Physicians; Practice Patterns, Physicians' - statistics & numerical data; Practice Patterns, Physicians' - trends; Prescription drug abuse; Prescription Drug Misuse - trends; Prescription drugs; Prescription writing; Prescriptions (Drugs); Public health; Quality Indicators, Health Care; Race; Widening; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0159224

Prescription drug abuse is a growing problem nationally. In an effort to curb this problem, emergency physicians might rely on subjective cues such as race-ethnicity, often unknowingly, when prescribing opioids for pain-related complaints, especially for conditions that are often associated with drug-seeking behavior. Previous studies that examined racial-ethnic disparities in opioid dispensing at emergency departments (EDs) did not differentiate between prescriptions at discharge and drug administration in the ED. We examined racial-ethnic disparities in opioid prescription at ED visits for pain-related complaints often associated with drug-seeking behavior and contrasted them with conditions objectively associated with pain. We hypothesized a priori that racial-ethnic disparities will be present among opioid prescriptions for conditions associated with non-medical use, but not for objective pain-related conditions. Using data from the National Hospital Ambulatory Medical Care Survey for 5 years (2007-2011), the odds of opioid prescription during ED visits made by non-elderly adults aged 18-65 for 'non-definitive' conditions (toothache, back pain and abdominal pain) or 'definitive' conditions (long-bone fracture and kidney stones) were modeled. Opioid prescription at discharge and opioid administration at the ED were the primary outcomes. We found significant racial-ethnic disparities, with non-Hispanic Blacks being less likely (adjusted odds ratio ranging from 0.56-0.67, p-value < 0.05) to receive opioid prescription at discharge during ED visits for back pain and abdominal pain, but not for toothache, fractures and kidney stones, compared to non-Hispanic whites after adjusting for other covariates. Differential prescription of opioids by race-ethnicity could lead to widening of existing disparities in health, and may have implications for disproportionate burden of opioid abuse among whites. The findings have important implications for medical provider education to include sensitization exercises towards their inherent biases, to enable them to consciously avoid these biases from defining their practice behavior.