Unequal Relief: Sex Disparities in Opioid Use for Cardiac Chest Pain in the Emergency Department

Acute chest pain, commonly caused by coronary artery disease, is a frequent reason for emergency department (ED) visits. While sex disparities in the evaluation and treatment of chest pain are well known, there is limited research on sex differences in the use of opioid analgesics for this condition in the ED. In this study we aimed to evaluate sex differences in the administration of opioid analgesics (morphine and fentanyl) and to compare the time to medication administration in patients presenting with acute cardiac chest pain.

This retrospective observational study included adult patients (≥ 18 years of age) presenting with acute cardiac chest pain and confirmed elevated troponin between 2019-2024. The primary outcome was receipt of intravenous (IV) morphine and/or IV fentanyl. The secondary outcome was time from medication order to administration. For male vs female comparisons, we used t-tests or Mann-Whitney U tests for continuous variables, and chi-square tests for categorical variables. Logistic and linear regression analyses were performed to assess sex differences in opioid administration and time to medication, adjusting for potential confounders.

A total of 2,168 patients were included in the study, with 924 females (42.6%). Among morphine recipients, the median initial IV morphine dose was 5 mg (interquartile range [IQR] 4-5 mg; range 2-6 mg). Males had higher adjusted odds of receiving morphine compared to females (adjusted odds ratio [OR] 1.28, 95% CI, 1.04-1.57, P = .02). Females had a longer unadjusted time from order to morphine administration (median 11 minutes [IQR 6-20] vs 9 minutes [IQR 4-17]; P = .003). Time to fentanyl administration did not differ by sex. In adjusted analyses, there were no significant sex differences in time to morphine or fentanyl administration.

This study identifies significant sex disparities in the administration of morphine to patients with acute chest pain. After adjusting for other factors, male patients had higher odds of receiving IV morphine compared to females. These findings highlight the need for further research to understand the underlying causes of these disparities and to develop strategies to ensure equitable chest pain management in the ED.