Racial and Ethnic Disparities in Opioid Prescriptions in Benign and Malignant Pancreatic Disease in the United States

Abstract

ObjectivesRacial-ethnic disparities in pain management are common but not known among pancreatic disease patients. We sought to evaluate racial-ethnic disparities in opioid prescriptions for pancreatitis and pancreatic cancer patients.MethodsData from the National Ambulatory Medical Care Survey were used to examine racial-ethnic and sex differences in opioid prescriptions for ambulatory visits by adult pancreatic disease patients.ResultsWe identified 207 pancreatitis and 196 pancreatic cancer patient visits, representing 9.8 million visits, but weights were repealed for analysis. No sex differences in opioid prescriptions were found among pancreatitis (P = 0.78) or pancreatic cancer patient visits (P = 0.57). Opioids were prescribed at 58% of Black, 37% of White, and 19% of Hispanic pancreatitis patient visits (P = 0.05). Opioid prescriptions were less common in Hispanic versus non-Hispanic pancreatitis patients (odds ratio, 0.35; 95% confidence interval, 0.14–0.91; P = 0.03). We found no racial-ethnic differences in opioid prescriptions among pancreatic cancer patient visits.ConclusionsRacial-ethnic disparities in opioid prescriptions were observed in pancreatitis, but not pancreatic cancer patient visits, suggesting possible racial-ethnic bias in opioid prescription practices for patients with benign pancreatic disease. However, there is a lower threshold for opioid provision in the treatment of malignant, terminal disease.

Racial and Ethnic Disparities in Opioid Prescriptions for Patients with Abdominal Pain: Analysis of the National Ambulatory Medical Care Survey

“…Further-more, the current guidelines do not support nor provide guidelines for the opioid-based treatment of non-malignant pain and may be variably influenced by disease characteristics. For example, in another NAMCS-based study, racial and ethnic disparities were seen in benign pancreatic disease, but not in malignant pancreatic disease, which points to a more standardized approach to pain management in malignant disease which potentially reduces biases [15].…”

“…As we have previously explored in regard to opioid prescription disparities in pancreatic disease [15], provider bias may not fully account for racial-ethnic differences in opioid prescriptions. Broader social, environmental, and economic factors may also explain the disparities seen in our analysis.…”

“…However, there is limited data available that have evaluated the racial and ethnic disparities in this population. We have previously shown that outpatient visits by Hispanic patients were less likely to record opioid prescriptions when compared to visits by non-Hispanic Blacks and Whites for pain control in benign pancreatic disease [15].…”

Interventions for Pancreatitis—New Approaches, Knowledge Gaps, and Research Opportunities

“…Disparities in mortality rates have been documented for CP in Black males compared with White males, 9 and disparities in pain management and quality of pain care have been documented across racial minority groups. 10,11 Racial minorities are underrepresented in pain intervention RCTs. In fact, race distribution is underreported in clinical trials of pain, making the disparity difficult to enumerate.…”