Factors Related to Adherence to Opioids in Black Patients With Cancer Pain

Yeager, Katherine A.; Williams, Bryan L.; Bai, Jinbing; Cooper, Hannah L.F.; Quest, Tammie E.; Meghani, Salimah H.; Bruner, Deborah Watkins

doi:10.1016/j.jpainsymman.2018.10.491

Cited by 28 publications

(23 citation statements)

References 44 publications

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“…This finding is consistent with prior work demonstrating that black patients are less likely to receive opioid analgesics compared to white patients 19–21 . Black patients with cancer also report difficulty in obtaining opioids from the pharmacy and adhering to an opioid prescription schedule 22,23 . Opioid use disparities may explain the perception of poorer pain control in black patients with cancer 24 .…”

Section: Discussionsupporting

confidence: 84%

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Opioid use patterns in patients with head and neck cancer receiving radiation therapy: Single‐institution retrospective analysis characterizing patients who did not require opioid therapy

et al. 2021

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Background We had previously analyzed the variables that determine the rates of opioid use at 1‐year postradiotherapy in patients with head and neck cancer. Here we analyze the variables associated with opioid abstinence during and in the 12 months after radiotherapy at our institution. Methods We identified a cohort of patients with head and neck cancer who received radiotherapy as part of curative treatment at our institution. Logistic regression analyses were performed to determine socioeconomic and clinical factors associated with opioid abstinence. Results The cohort included 376 patients. On multivariable analysis, patients from an upper‐income class (p = 0.004), black race (p = 0.004), older (p = 0.008), with dependent children (p < 0.001) or receiving surgery (p = 0.002) were more likely to abstain from opioids, while patients using analgesic mouthwash (p = 0.009) or higher pain scale (p = 0.002) were less likely. Conclusion Socioeconomic and treatment characteristics are associated with opioid abstinence during and following radiation treatment in patients with head and neck cancer.

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Section: Discussionsupporting

confidence: 84%

“…[19][20][21] Black patients with cancer also report difficulty in obtaining opioids from the pharmacy and adhering to an opioid prescription schedule. 22,23 Opioid use disparities may explain the perception of poorer pain control in black patients with cancer. 24 Patients from upper income zip codes were less likely to use opioids.…”

Section: Characteristicmentioning

confidence: 99%

Opioid use patterns in patients with head and neck cancer receiving radiation therapy: Single‐institution retrospective analysis characterizing patients who did not require opioid therapy

et al. 2021

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“…Even though African-Americans are undertreated with opioid-based medications, they are at higher odds for opioid abuse and dependence as opposed to Whites [ 49 ]. African Americans’ adherence to pain medication may be decreased, and adherence to opioids may be worsened with around-the-clock use [ 50 ]. Opioids may provide short-term relief for arthritic and back pain, but long-term efficacy is unknown, with greater potential for dependency and misuse.…”

Section: Discussionmentioning

confidence: 99%

Psychotropic and Opioid-Based Medication Use among Economically Disadvantaged African-American Older Adults

et al. 2020

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African-American older adults, particularly those who live in economically deprived areas, are less likely to receive pain and psychotropic medications, compared to Whites. This study explored the link between social, behavioral, and health correlates of pain and psychotropic medication use in a sample of economically disadvantaged African-American older adults. This community-based study recruited 740 African-American older adults who were 55+ yeas-old in economically disadvantaged areas of South Los Angeles. Opioid-based and psychotropic medications were the outcome variables. Gender, age, living arrangement, socioeconomic status (educational attainment and financial strain), continuity of medical care, health management organization membership, sleeping disorder/insomnia, arthritis, back pain, pain severity, self-rated health, depressive symptoms, and major chronic conditions were the explanatory variables. Logistic regression was used for data analyses. Arthritis, back pain, severe pain, and poor self-rated health were associated with opioid-based medications. Pain severity and depressive symptoms were correlated with psychotropic medication. Among African-American older adults, arthritis, back pain, poor self-rated health, and severe pain increase the chance of opioid-based and psychotropic medication. Future research should test factors that can reduce inappropriate and appropriate use and prescription of opioid-based and psychotropic medication among economically disadvantaged African-American older adults.

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“…We measured pain intensity and impact using the Brief Pain Inventory (BPI) (Cleeland & Ryan, 1994). The psychometric properties of the BPI are well established with cancer patients, including racial and ethnic minority patients with cancer (Anderson et al, 2000;Meghani & Keane, 2007;Rhee et al, 2012;Yeager et al, 2019).…”

Section: Pain Intensitymentioning

confidence: 99%

“…Although we know that African Americans are less likely to receive opioids for pain across care settings (Meghani et al, 2012) and are more likely to have a negative pain management index (Cintron & Morrison, 2006;Minick et al, 2012), it is not clear if there are also disparities in the types of strong opioids or World Health Organization Step 3 opioids (World Health Organization, 1996) (e.g., morphine, oxycodone) prescribed to African Americans with cancer pain. This understanding is important for a few reasons: Emerging literature points to poor adherence to prescribed analgesia among African Americans even with a higher burden of cancer-related pain (Meghani & Knafl, 2016;Rhee, Kim, & Kim, 2012;Stout, Sexton, & Meghani, 2017;Yeager et al, 2019). These studies suggest that experience of analgesic side effects secondary to the type of analgesia prescribed to African Americans despite clinical risks may contribute to poor adherence and lack of pain control.…”

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confidence: 99%

Both Race and Insurance Type Independently Predict the Selection of Oral Opioids Prescribed to Cancer Outpatients

Meghani

Rosa

Chittams

et al. 2020

Pain Management Nursing

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a b s t r a c tBackground: Previous research suggests that racial disparities in patients' reported analgesic adverse effects are partially mediated by the type of opioid prescribed to African Americans despite the presence of certain comorbidities, such as renal disease. Aims: We aimed to identify independent predictors of the type of opioid prescribed to cancer outpatients and determine if race and chronic kidney disease independently predict prescription type, adjusting for relevant sociodemographic and clinical confounders. Design: We conducted a secondary analysis of a 3-month observational study. Setting: Outpatient oncology clinics of an academic medical center. Participants/Subjects: Patients were older than 18 years of age, self-identified as African American or White, and had an analgesic prescription for cancer pain. Methods: Cancer patients (N ¼ 241) were recruited from outpatient oncology clinics within a large mid-Atlantic healthcare system. Results: Consistent with published literature, most patients (75.5%) were prescribed either morphine or oxycodone preparations as oral opioid therapy for cancer pain. When compared with Whites, African Americans were significantly more likely to be prescribed morphine (33% vs 14%) and less likely to be prescribed oxycodone (38% vs 64%) (p < .001). The estimated odds for African Americans to receive morphine were 2.573 times that for Whites (95% confidence interval 1.077-6.134) after controlling for insurance type, income, and pain levels. In addition, the presence of private health insurance was negatively associated with the prescription of morphine and positively associated with prescription of oxycodone in separate multivariable models. The presence of chronic kidney disease did not predict type of analgesic prescribed. Conclusions: Both race and insurance type independently predict type of opioid selection for cancer outpatients. Larger clinical studies are needed to fully understand the sources and clinical consequences of racial differences in opioid selection for cancer pain.

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Factors Related to Adherence to Opioids in Black Patients With Cancer Pain

Cited by 28 publications

References 44 publications

Opioid use patterns in patients with head and neck cancer receiving radiation therapy: Single‐institution retrospective analysis characterizing patients who did not require opioid therapy

Opioid use patterns in patients with head and neck cancer receiving radiation therapy: Single‐institution retrospective analysis characterizing patients who did not require opioid therapy

Psychotropic and Opioid-Based Medication Use among Economically Disadvantaged African-American Older Adults

Both Race and Insurance Type Independently Predict the Selection of Oral Opioids Prescribed to Cancer Outpatients

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