Racial differences in prescription of opioid analgesics for chronic noncancer pain in a national sample of veterans.
The purpose of this study was to investigate possible racial differences in opioid prescriptions among primary care patients with chronic noncancer pain receiving care in the Veterans Affairs health care system. This was a retrospective cohort study of 99,903 veterans with diagnoses of low back, neck, or joint pain selected to participate in the Veterans Affairs Survey of the Healthcare Experiences of Patients in fiscal year 2006. The outcome was prescription of opioids in the year following the first pain diagnosis, obtained through electronic medical record data. Analyses incorporated fixed effects for race, most recent pain intensity rating, new or established primary care patient status, and an interaction between race and most recent pain intensity rating, together with random effects for health care facility and race within facility. The association between patient race and prescription of opioids was moderated by baseline level of pain intensity scores (assessed on a 0-10 scale) and patient age. Among patients under 65 years of age, blacks with moderate (4-6) or high (7-10) levels of pain were less likely to receive opioids than whites (P = .0025, P = .0011); however, there were no significant differences between black and white patients with low levels of pain intensity (1-3) and those with pain intensity ratings of 0 (no pain). Among patients 65 and older with pain intensity ratings of zero, blacks were more likely than whites to receive opioid prescriptions (P = .0087), but there were no significant racial differences in opioid prescriptions in those with low to high levels of pain.


CONCLUSIONS
Among veterans under age 65 reporting moderate to high levels of chronic noncancer pain, blacks were less likely to be prescribed opioids than whites, even after controlling for clinical and system-level factors. Results underscore the challenges of eliminating racial differences in pain treatment, despite comprehensive systemwide improvement initiatives.
Center for Chronic Disease Outcomes Research, VA Minneapolis Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota. Electronic address: Diana.Burgess@va.gov.
Diana J
DJ
Burgess
Center for Chronic Disease Outcomes Research, VA Minneapolis Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
David B
DB
Nelson
Center for Chronic Disease Outcomes Research, VA Minneapolis Healthcare System, Minneapolis, Minnesota.
Amy A
AA
Gravely
Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; School of Medicine, Indiana University, Indianapolis, Indiana; Regenstrief Institute Inc, Indianapolis, Indiana.
Matthew J
MJ
Bair
VA Connecticut Healthcare System, West Haven, Connecticut; Yale University, New Haven, Connecticut.
Robert D
RD
Kerns
VA Connecticut Healthcare System, West Haven, Connecticut; Yale University, New Haven, Connecticut.
Diana M
DM
Higgins
Mayo Clinic, Rochester, Minnesota.
Michelle
M
van Ryn
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California.
Melissa
M
Farmer
Center for Chronic Disease Outcomes Research, VA Minneapolis Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Melissa R
MR
Partin
D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D044383:Black People; D059350:Chronic Pain / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014728:Veterans; D044465:White People
D000701:Analgesics, Opioid
Opioids; chronic pain; disparities; race; veterans