Opioid Prescribing Disparity in Traumatically Injured Patients

Opioid prescribing is understudied in trauma patients, where disadvantaged communities are overrepresented. In this study, we evaluated disparities in opioid administration after trauma.

We conducted a retrospective cohort study of injured adults at a Level I trauma center, 2018 to 2021. Opioids were quantified in milligram morphine equivalents (MMEs). Primary outcomes were receipt of opioids inpatient and at discharge, MMEs per hospital day, and, for patients prescribed opioids at discharge, MMEs and discharge pain control days. Multivariable logistic regression identified factors associated with overall receipt of opioids after injury, general linear modeling identified factors associated with MMEs received inpatient and at discharge, and negative binomial regression evaluated pain control days prescribed at discharge.

Of 3,032 patients, 2,514 (82.92%) required opioids as an inpatient and 1,803 (71.72%) still required opioids the day of discharge. Of these, 1,310 (72.66%) were discharged with opioids. Black (β -24.94, 95% CI -37.25 to -12.62, p < 0.001) and Hispanic (β -21.96, 95% CI -39.21 to -4.71, p = 0.01) patients received lower MMEs while inpatient. Factors associated with lower odds of discharge with opioids included non-English language (odds ratio [OR] 0.56, 95% CI 0.38 to 0.82, p = 0.003), substance use disorder (OR 0.69, 95% CI 0.49 to 0.97, p = 0.03), neuropsychiatric comorbidity (OR 0.58, 95% CI 0.39 to 0.87, p = 0.008), and violent injury (OR 0.61, 95% CI 0.45 to 0.85, p = 0.003). On discharge, Black individuals (β -130.71, 95% CI -251.26 to -10.17, p = 0.03) received lower MMEs and patients with substance use disorder (incidence rate ratio 0.65, 95% CI 0.53 to 0.80, p < 0.001) received fewer pain control days.

Trauma patients experienced disparities in opioid prescribing throughout hospitalization. Lower opioid doses were administered to non-White patients, while language, mental health comorbidity, and mechanism influenced discharge opioid prescriptions.