title: Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse.
abstract: 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.
authors: Health Policy and Health Services Research, Boston University School of Dental Medicine, Boston, Massachusetts, United States of America.
authors: Astha
authors: http://orcid.org/0000-0001-9191-6978
authors: A
authors: Singhal
authors: University of Iowa College of Pharmacy, Iowa City, Iowa, United States of America.
authors: Yu-Yu
authors: YY
authors: Tien
authors: Department of Emergency Medicine and Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, California, United States of America.
authors: Renee Y
authors: RY
authors: Hsia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends*; D058999:Drug-Seeking Behavior; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data* / Q000639:trends; D005006:Ethnicity / Q000145:classification / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000208:ethnology* / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D063487:Prescription Drug Misuse / Q000639:trends*; D019984:Quality Indicators, Health Care; D044469:Racial Groups; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid