title: Racial differences in primary care opioid risk reduction strategies.
abstract: OBJECTIVE
  Racial disparities in treating pain with opioids are widely reported; however, differences in use of recommended strategies to reduce the risk of opioid misuse by race/ethnicity have not been evaluated.
  
  
  METHODS
  In a retrospective cohort of black and white patients with chronic noncancer pain prescribed opioid analgesics for at least 3 months, we assessed physicians' use of 3 opioid risk reduction strategies: (1) urine drug testing, (2) regular office visits (at least 1 visit per 6 months on opioids and within 30 days of an opioid change), and (3) restricted early opioid refills (receipt of a refill >1 week early less than twice). Nonlinear mixed effect regression models accounted for clustering within physician and adjusted additively for demographics, substance abuse, mental health and medical comorbidities, health care factors, and practice site.
  
  
  RESULTS
  Of the 1,612 patients studied, 62.1% were black. Black patients were more likely than white patients to receive urine drug testing (10.4% vs 4.1%), regular office visits (56.4% vs 39.0%), and restricted early refills (79.4% vs 72.0%) (P <.001 for each). In fully adjusted models, black patients had significantly higher odds than their white counterparts of receiving regular office visits (odds ratio = 1.51; 95% confidence interval, 1.06-2.14) and restricted early refills (odds ratio = 1.55; 95% confidence interval, 1.03-2.32), but not urine drug testing (odds ratio = 1.41; 95% confidence interval, 0.78-2.54).
  
  
  CONCLUSIONS
  In this cohort of primary care patients receiving opioid analgesics on a long-term basis, use of risk reduction strategies was very limited overall; however, black patients were more likely than white patients to receive 2 of 3 guideline-recommended strategies. These data raise questions about lax monitoring, especially for white patients taking opioids long term.
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Becker
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Starrels
authors.forename: Moonseong
authors.initials: M
authors.lastname: Heo
authors.forename: Xuan
authors.initials: X
authors.lastname: Li
authors.forename: Mark G
authors.initials: MG
authors.lastname: Weiner
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
mesh_terms: D001741:Black or African American; D000701:Analgesics, Opioid / Q000378:metabolism / Q000627:therapeutic use* / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D017751:Safety Management; D014481:United States; D016482:Urinalysis; D044465:White People
chemical_list: D000701:Analgesics, Opioid