Racial disparities in chronic opioid prescriptions following burn injury: a retrospective cohort study

Chronic pain is a common and debilitating outcome for many burn patients, necessitating effective and equitable pain management. Although opioids are routinely prescribed for severe and chronic pain, prior studies have shown that Black patients are less likely to receive opioid prescriptions than White patients, raising concerns about racial disparities in pain treatment. This study aimed to investigate whether such disparities in opioid prescribing extend to other racial and ethnic groups following burn injury. Using the TriNetX database, we identified adult patients (≥18 years) diagnosed with both burn injuries and chronic pain between January 1, 2016, and January 1, 2023. To reduce confounding, cohorts were propensity score matched for age, burn severity, and comorbidities. We then examined differences in opioid prescription rates at six- and twelve-months post-injury using univariate regression models, calculating odds ratios (ORs) with statistical significance set at P<.05. Among 32 167 burn patients with chronic pain, 63.66% (n = 20 478) were White, 17.80% (n = 5726) Black or African American, 2.57% (n = 827) Asian, 1.09% (n = 351) Native Hawaiian, and 0.60% (n = 193) American Indian. Compared to White patients, the odds of receiving an opioid prescription were significantly lower for Black (OR: 0.693, P<.0001), Asian (OR: 0.576, P=.0135), Native Hawaiian (OR: 0.313, P=.0074), and Other Race patients (OR: 0.641, P=.0081). No significant difference was observed for American Indian patients (OR: 0.809, P=.6689). While racial differences in the prevalence of chronic pain were observed, our analysis specifically focused on treatment disparities within those already diagnosed with chronic pain. These findings reveal inequities in opioid prescribing practices for chronic pain management after burn injuries and underscore the need for policy-level changes to promote equitable care across all racial and ethnic groups.