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Inequities in Opioid Administration by Race and Ethnicity for Hospitalized Patients With and Without Substance Use
Aksharananda Rambachan1, Margaret C Fang2
1Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. aksharananda.rambachan@ucsf.edu.
Background:
Adequate pain management is challenging in patients with substance use disorders, particularly those from racial/ethnic minority groups who face intersecting biases.
Objective:
To investigate inequities in pain management for racial/ethnic minority groups with and without concurrent substance use disorders.
Design:
Retrospective cohort study from 2021 to 2022 on an acute care general medicine service at UCSF Medical Center.
Participants:
All adults ≥ 18 years old.
Exposures:
Primary exposure was the patient's self-identified race/ethnicity (Asian, Black or African American, Latino, Multi-Race/Ethnicity, Native American or Alaska Native, Native Hawaiian or Pacific Islander, Southwest Asian or North African, White, Other, and Unknown/Declined).
Main Outcome And Measures:
The primary outcome was average daily inpatient opioids received (morphine milligram equivalents, MME). Multivariable negative binomial regression assessed the relationship between self-reported race/ethnicity and opioid administration, adjusting for demographics, clinical factors, substance use disorders, and pain characteristics. The subgroup analyses focused on patients with substance use disorders and on patients without any buprenorphine or methadone prescriptions.
Key Results:
In the overall cohort of 13,058 hospitalizations (mean age 62.7 years, 51.2% male, 31.3% with substance use disorder), patients from racial/ethnic minority groups received significantly fewer opioids than White patients in adjusted analyses: Asian (- 61.3 MME/day), Black (- 44.9 MME/day), Latino (- 48.8 MME/day), Native American/Alaska Native (- 80.4 MME/day), and Native Hawaiian/Pacific Islander (- 72.9 MME/day). Similar, significant disparities were present in both subgroups. Notably, in the substance use disorder-only subgroup (n = 4446), larger disparities persisted for Asian (- 124.4 MME/day), Black (- 68.7 MME/day), and Latino (- 110.8 MME/day) patients compared to White patients.
Conclusions:
Substantial racial/ethnic inequities in inpatient opioid prescribing for pain control were observed, particularly among patients with concurrent substance use disorders. These findings highlight the need for interventions promoting equitable, culturally competent pain management for marginalized populations facing intersecting biases and stigma.
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