October 5, 2021
3 minute reading
Disclosure: Ly reports that this research was supported by the National Institute on Aging.
According to findings published in the journal, primary care physicians prescribe opioids for low back pain to white patients more often than patients in historically underrepresented groups. JAMA Health Forum.
Prejudice permeates many decisions made by doctors, Dan Ly, MD, PhD, MPP, An assistant professor in the Department of General Internal Medicine and Health Services Research at UCLA told Healio Primary Care.
In a cross-sectional study, Ly and colleagues analyzed medical insurance data for beneficiaries 66 years of age or older who sought treatment from PCP for low back pain from 2007 to 2014. Researchers investigated the trend of long-term use of prescription opioids for 180 days or more.
The study cohort included 274,771 patients who had at least one new episode of low back pain within 1 year. The average age of the beneficiaries is 77.1 years. Nearly 70% are women, 81% are white, 6% are black, 6% are Asian or Pacific Islanders, and 8% are Hispanics. These patients were treated by 63,494 doctors.
Analysis by Ly and colleagues showed that an average of 11.5% (95% CI, 11.4-11.6) of white patients took opioids in the first year of new low back pain. However, only 9.9% (95% CI, 9.3-10.6) of black patients, 8.8% (95% CI, 8-9.6) of Asian or Pacific Islander patients, and 10.5% (95% CI, 9.8-11.1) were prescribed Opioids) Hispanic patients.
Compared with white patients, doctors are 1.5 percentage points less likely to prescribe opioids to black patients (95% CI, -2.2 to -0.8), and 2.7 percentage points less likely to prescribe opioids to black patients ( 05% CI, -3.5 to -1.8) Prescribing opioids to Asian or Pacific Islander patients, and 1 percentage point less likely to prescribe opioids to Hispanic patients (95% CI, -1.7 to -0.3).
Researchers say that patients from underrepresented groups are more likely to receive NSAID prescriptions for low back pain. At the same time, compared with Asian or Pacific Islander, black and Hispanic patients, white patients with low back pain taking opioids are 0.4% to 1.3% more likely to develop long-term opioid use disorders.
Healio Primary Care discussed more with Ly about the differences in health care illustrated by the research results.
Helio Primary health care: What prompted this research?
plum: We know that compared with white patients, minority patients are less likely to receive opioids, but this may be due to the fact that minority patients see fewer opioid prescription doctors. As far as I know, no one can check whether the same doctor prescribes different opioids for minority patients. I found that this is the case: the same doctor is less likely to prescribe opioids for minority patients with new low back pain, but is more likely to prescribe non-steroidal anti-inflammatory drugs for minority patients.
Helio Primary health care: You have observed that white patients take opioids more often for low back pain than other races or ethnicities. However, opioid abuse is more common among whites. Can you talk about this?
plum: I saw a clinical situation. When a patient who has not used opioids develops new low back pain and goes to the PCP and checks whether the doctor’s few patients receive different pain treatments than white patients of the same doctor, it seems that white patients are more likely to receive opioids, although , You said, opioid abuse is more common among whites. It may be that doctors have low trust in minority patients, which may cause some of these prescription differences.
Helio Primary health care: What is the clinical relevance of the results of the study, for racial and ethnic patients who do not use opioids frequently due to pain, and white patients who may be at higher risk for Addicted to opioids?
profit: Doctors seem to play an important role in the differentiated care received by patients of different races and ethnicities. That is, when the decision is self-determined like pain treatment, minority patients seem to receive different care from white patients with the same doctor.
Helio Primary health care: What do you think caused these differences in drug prescriptions? In terms of unequal treatment of pain, how will this affect the long-term health of patients?
plum: Unfortunately, I believe that doctors’ prejudices and different trust in patients have caused most of the differences in opioid prescriptions.
This differentiated prescription may lead to long-term use of opioids in white patients.
Helio Primary health care: What should a doctor recommend for low back pain?
profit: My specialty is not to treat pain, including low back pain. However, advice usually states that opioids are the last resort. In the past, ACP recommended non-drug therapies, such as hot compresses and massage, and physical therapy may prevent the use of opioids. If medications, NSAIDs and muscle relaxants are needed, if there are no contraindications, they should probably be tried before resorting to opioids.
Lee DP. JAMA Health Forum. 2021; doi: 10.1001/jamahealthforum.2021.2333.