Racial inequities in U.S. naloxone prescriptions

Background: Research indicates U.S. racial and ethnic minority patients are prescribed opioids for pain less often than non-Hispanic Whites. Racial inequities are strongest for pain conditions with uncertain prognosis (e.g., chronic pain syndrome) compared to acute pain with defined duration (e.g., fractures). As naloxone, an opioid overdose reversal drug, becomes more popular among prescribers in clinical contexts, it is unclear whether racial inequities also extend to naloxone prescriptions. Methods: Patients diagnosed with bone fracture (n = 551,103) or chronic pain syndrome [CPS] (n = 173,341) were identified using ICD-9 and ICD-10 codes in electronic health records from the Health Facts® Database. Logistic regressions were used to determine whether the likelihood of receiving a prescription for opioids or a co-prescription for opioids and naloxone differ by patient race/ethnicity, which included African American, Native American, Non-Hispanic White, Asian/Pacific Islander, Hispanic, and "other" categories. Results: Multiple logistic regressions show naloxone prescriptions do not consistently mirror trends in opioid prescriptions when broken down by patient race/ethnicity and diagnosis. Patients of color with bone fracture or CPS are largely less likely to receive prescriptions for outpatient opioid analgesics than their non-Hispanic White counterparts. Among bone fracture patients prescribed opioids, African Americans and patients of "other" race/ethnicity are also significantly less likely to receive naloxone prescriptions. However, Native American and Hispanic CPS patients prescribed opioids are more likely to get naloxone prescriptions despite being less likely to get opioid prescriptions. And while Native American and Asian/Pacific Islander fracture patients and "other" race/ethnicity CPS patients are less likely to receive an opioid prescription than non-Hispanic Whites, there is no difference from non-Hispanic Whites in their likelihood of receiving a naloxone prescription. Conclusions: Among patients prescribed opioids, naloxone prescriptions vary by patient race/ethnicity and by health condition, indicating the need for efforts to assure equitable diffusion of this harm reduction intervention.