Racial disparities in the monitoring of patients on chronic opioid therapy

Pain. 2013 Jan;154(1):46-52. doi: 10.1016/j.pain.2012.07.034.

Abstract

Despite well-documented racial disparities in prescribing opioid medications for pain, little is known about whether there are disparities in the monitoring and follow-up treatment of patients who are prescribed opioid medications. We conducted a retrospective cohort study to examine whether there are racial differences in the use of recommended opioid monitoring and follow-up treatment practices. Our sample included 1646 white and 253 black patients who filled opioid prescriptions for noncancer pain for ≥ 90 consecutive days at the Veterans Affairs Pittsburgh Healthcare System pharmacy in fiscal years 2007 and 2008. Several opioid monitoring and follow-up treatment practices were extracted from electronic health records for a 12-month follow-up period. Findings indicated that 26.3% of patients had opioid agreements on file, pain was documented in 71.7% of primary care follow-up visits, urine drug tests were administered to 49.3% of patients, and 21.2% and 4.2% of patients were referred to pain and substance abuse specialists, respectively. Racial differences were observed in several of these practices. In adjusted comparisons, pain was documented less frequently for black patients than for white patients. Among those who had at least 1 urine drug test, black patients were subjected to more tests, especially if they were on higher doses of opioids. Compared with white patients, black patients were less likely to be referred to a pain specialist and more likely to be referred for substance abuse assessment. Addressing disparities in opioid monitoring and follow-up treatment practices may be a previously neglected route to reducing racial disparities in pain management.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • African Continental Ancestry Group / statistics & numerical data*
  • Aged
  • Analgesics, Opioid / therapeutic use*
  • Chronic Pain / drug therapy*
  • Chronic Pain / ethnology*
  • Drug Monitoring / statistics & numerical data*
  • Drug Prescriptions / statistics & numerical data
  • Electronic Health Records / statistics & numerical data
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pain Clinics / statistics & numerical data
  • Referral and Consultation / statistics & numerical data
  • Retrospective Studies
  • Substance Abuse Detection / statistics & numerical data
  • Veterans / statistics & numerical data

Substances

  • Analgesics, Opioid