Tuesday, December 17, 2013

Poor and Non-Whites Less Likely to Receive Opioid for Pain in ERs

Race and Socioeconomic Status Affect Emergency Department Opioid Prescribing for Pain

Prior research suggests that factors besides pain—such as patient race and ethnicity—affect opioid prescribing for pain, but those studies have often not adjusted for socioeconomic status (SES). In this study, investigators examined the association between race, ethnicity, and neighborhood SES on prescription of an opioid during an emergency department (ED) visit for moderate or severe pain in the National Hospital Ambulatory Care Survey. During 4 years there were over 183 million visits and opioids were prescribed during 50,264 of them.
  • Compared with patients living in areas with the highest SES, patients living in areas with the lowest SES were less likely to receive opioids (39% versus 49% when neighborhood poverty was >20%; 41% versus 47% when median income was <$33,000; and 43% versus 46% when <13 a="" bachelor="" degree="" held="" li="" s="">
  • Black (39% versus 46% for white) and Hispanic (40% versus 45% for non-Hispanic) patients were less likely to receive opioids.
  • All differences were significant in analyses adjusted for race, ethnicity, SES, sex, pain severity, injury, hospital type, past ED visits, and geography.

Comments:

This study adjusted for neighborhood rather than individual SES. Nonetheless, it does provide support for the hypothesis that race, ethnicity, and SES impact opioid receipt for pain. Clinicians should be aware that this may happen, and researchers should attend to discovering why, with an eye toward eliminating any inappropriate disparities.Richard Saitz MD, MPH

Reference:

Joynt M, Train MK, Robbins BW, et al. The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United StatesJ Gen Intern Med. 2013 [Epub ahead of print]. PMID: 23797920.

1 comment:

  1. It's possible that ER docs assume patients from minority and low-income groups are more likely to abuse or divert their prescribed opioid. Physician bias and negative stereotypes influence their prescribing patterns in other patient demographics. Studies have found that although women have higher prevalence rates of chronic pain and chronic pain with psychiatric co-morbidity, men are prescribed opioids for pain at higher rates than women. A contributing factor is the overexpression of 'functional' pain syndromes (e.g., lacking obvious tissue injury, damage or disease) such as fibromyalgia and irritable bowel syndrome in women, which may be labelled as merely a psychogenic issue. This is unfortunate because patients in real distress feel the dismissive attitude of their physician. It also reflects gaps in provider knowledge because functional pain syndromes are now known to reflect dysregulation in central pain processing pathways, amenable to CNS-targeted drug therapies.

    Mark Edmund Rose, MA.
    Licensed Psychologist

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