Racial Differences in Primary Care Opioid Risk Reduction Strategies

被引:95
作者
Becker, William C. [3 ]
Starrels, Joanna L. [4 ,5 ]
Heo, Moonseong [4 ,5 ]
Li, Xuan [4 ,5 ]
Weiner, Mark G. [1 ,2 ]
Turner, Barbara J. [1 ,2 ]
机构
[1] Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78209 USA
[2] Univ Hlth Syst, San Antonio, TX USA
[3] Yale Univ, Sch Med, New Haven, CT USA
[4] Albert Einstein Coll Med, Bronx, NY 10467 USA
[5] Montefiore Med Ctr, Bronx, NY 10467 USA
关键词
Opioid analgesics; safety monitoring; disparities; urine drug testing; race/ethnicity; practice-based research; primary care; CHRONIC NONCANCER PAIN; PRESCRIPTION OPIOIDS; MEDICAL-CARE; PHYSICIANS; OVERDOSE; ABUSE; RACE/ETHNICITY; DISPARITIES; EMERGENCY; PATTERNS;
D O I
10.1370/afm.1242
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
PURPOSE 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.
引用
收藏
页码:219 / 225
页数:7
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