title: Racial disparities across provider specialties in opioid prescriptions dispensed to medicaid beneficiaries with chronic noncancer pain.
abstract: OBJECTIVE
  Chronic pain affects both psychological and physical functioning, and is responsible for more than $60 billion in lost productivity annually in the United States. Although previous studies have demonstrated racial disparities in opioid treatment, there is little evidence regarding disparities in treatment of chronic noncancer pain (CNCP) and the role played by physician specialty in these disparities.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  We analyzed North Carolina Medicaid claims data, from July 1, 2009 to May 31, 2010, to examine disparities by different provider specialties in beneficiaries' dispensed prescriptions for opioids.
  
  
  METHODS
  The population included white and black North Carolina Medicaid beneficiaries with CNCP (N = 75,458).
  
  
  METHODS
  We used bivariate statistics and logistic regression analysis to examine race-based discrepancies in opioid prescribing by physician specialty.
  
  
  RESULTS
  Compared with white beneficiaries with CNCP (N = 49,197), black beneficiaries (N = 26,261) were less likely (odds ratio [OR] 0.91 [confidence interval {CI}: 0.88-0.94]) to fill an opioid prescription. Our hypothesis was partially supported: we found that race-based differences in beneficiaries' dispensed opioid prescriptions were more prominent in certain specialties. In particular, these differences were most salient among patients of specialists in obstetrics and gynecology (OR 0.78 [CI: 0.67-0.89]) and internal medicine (OR 0.86 [CI: 0.79-0.92]), as well as general practitioners/family medicine physicians (OR 0.91 [CI: 0.85-0.97]).
  
  
  CONCLUSIONS
  Our findings suggest that, in our study population, black beneficiaries with CNCP are less likely than whites to fill prescriptions for opioid analgesics as a function of their provider's specialty. Although race-based differences in patients filling opioid prescriptions have been noted in previous studies, this is the first study that clearly demonstrates these disparities by provider specialty.
authors.affiliation: Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Ringwalt
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Roberts
authors.forename: Hallam
authors.initials: H
authors.lastname: Gugelmann
authors.forename: Asheley Cockrell
authors.initials: AC
authors.lastname: Skinner
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000208:ethnology*; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D059408:Pain Management; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D044465:White People; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Chronic Pain; Opioids; Prescriptions; Primary Care