Patient race and opioid misuse history influence provider risk perceptions for future opioid-related problems.

Abstract

In response to the dual public health crises of chronic pain and opioid use, providers have become more vigilant about assessing patients for risk of opioid-related problems. Little is known about how providers are making these risk assessments. Given previous studies indicating that Black patients are at increased risk for suboptimal pain care, which may be related to stereotypes about drug abuse, the current study examined how patient race and previous opioid misuse behaviors impact providers’ risk assessments for future prescription opioid-related problems. Physician residents and fellows (N = 135) viewed videos and read vignettes about 8 virtual patients with chronic pain who varied by race (Black/White) and history of prescription opioid misuse (absent/present). Providers rated patients’ risk for future prescription opioid-related adverse events, misuse/abuse, addiction, and diversion, and also completed measures of implicit racial attitudes and explicit beliefs about race differences in pain. Two significant interactions emerged indicating that Black patients were perceived to be at greater risk for future adverse events (when previous misuse was absent) and diversion (when previous misuse was present). Significant main effects indicated that Black patients and patients with previous misuse were perceived to be at greater risk for future misuse/abuse of prescription opioids, and that patients with previous misuse were perceived to be at greater risk of addiction. These findings suggest that racial minorities and patients with a history of prescription opioid misuse are particularly vulnerable to any unintended consequences of efforts to stem the dual public health crises of chronic pain and opioid use.

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

“…Providers should also be mindful of implicit bias risks when assessing and treating pain. Multiple analyses have found that lower amounts of analgesics are routinely prescribed to Black and other patients of color despite higher degrees of self-reported pain, and that race influences prescriber perceptions of risk for opioid misuse [ 362 , 363 , 364 ].…”

Half the picture: Word frequencies reveal racial differences in clinical documentation, but not their causes

“…There are several possible explanations for why providers underestimate and undertreat Black patients’ pain, including incorrect provider beliefs about Black patients’ nerve endings and skin, 6 or suspicion that Black patients are more likely to abuse opioids than White patients. 24, 25 It is also possible that these results do not indicate bias, but instead represent racial trends in opioid abuse, since during this time period the opioid crisis disproportionately affected White Americans. 26 Both of these factors are likely to be intertwined in practice.…”

Patient Preference and Risk Assessment in Opioid Prescribing Disparities

“…This theory is consistent with the results of previous studies, which have found that clinicians make different pain management decisions in response to identical patient-level information when treating Black vs White patients. 18 , 32 …”