Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse

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 dru...

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Vydané v:	PloS one Ročník 11; číslo 8; s. e0159224
Hlavní autori:	Singhal, Astha, Tien, Yu-Yu, Hsia, Renee Y.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Public Library of Science 08.08.2016 Public Library of Science (PLoS)
Predmet:	Abdomen Adolescent Adult Adults Aged Ambulatory care Analgesics Analgesics, Opioid - therapeutic use Back pain Biology and Life Sciences Black people Continental Population Groups Cues Cultural differences Departments Discharge Disease control Dispensing Drug abuse Drug addiction Drug Utilization - statistics & numerical data Drug Utilization - trends Drug-Seeking Behavior Emergencies Emergency medical care Emergency medical services Emergency Service, Hospital - trends Emergency Service, Hospital - utilization Emergency services Engineering and Technology Ethnic Groups - classification Ethnic Groups - statistics & numerical data Ethnicity Family physicians Female Fractures Geriatrics Health aspects Health Care Surveys Healthcare Disparities - statistics & numerical data Healthcare Disparities - trends Hispanic people Hospital emergency services Hospitals Humans Kidney stones Kidneys Long bone Male Medical personnel Medicine and Health Sciences Middle Aged Minority & ethnic groups Mortality Narcotics Nephrolithiasis Older people Opioids Pain Pain - drug therapy Pain - ethnology Pain - etiology Patients People and Places Pharmacy Physicians Practice Patterns, Physicians' - statistics & numerical data Practice Patterns, Physicians' - trends Prescription drug abuse Prescription Drug Misuse - trends Prescription drugs Prescription writing Prescriptions (Drugs) Public health Quality Indicators, Health Care Race Widening Young Adult
ISSN:	1932-6203, 1932-6203
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Popis
Shrnutí:	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.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Competing Interests: The authors have declared that no competing interests exist. Conceived and designed the experiments: AS YT RH. Analyzed the data: AS YT. Wrote the paper: AS YT RH.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0159224