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Yale Study Shows Racial Disparities In Opioid Prescribing Habits

Opioid Pills
Robert F. Bukaty
Jeff Bacon shows some of the medication he takes for chronic back pain, in Hampden, Maine, in 2017.

Race plays a factor when doctors prescribe opioids to treat chronic pain. That’s the finding of a new study from Yale University. 

Researchers say black patients, who receive opioid painkillers such as Oxycontin and Percocet for long-term treatment, are more likely than whites to be tested for illicit drug use.  

And of those who are black and test positive, clinicians are more likely to stop prescribing opioids, even though research has shown that whites are the group at highest risk for overdose and death.  

Dr. Julie Gaither, the lead researcher on the study, recently spoke with Morning Edition host Tom Kuser about the study, which examined the records of 15,000 patients treated by the Veterans Administration. 

Credit Ann Lopez / WSHU
WSHU's Tom Kuser interviews Yale epidemiologist Julie Gaither on the findings of her study related to opioid prescribing habits by physicians.

Gaither said another key finding was how many patients remained on opioids even though they tested positive for controlled substances.   

Ninety percent of the 15,000 we tested continued to receive opioid therapy even after testing positive for cocaine or marijuana. And I think that’s particularly troubling because these are patients who are at higher risk for overdose because they are engaging in a behavior that could exacerbate the risk for overdose. 

So that occuring at the same time that the black patients were more likely than the white patients to lose their opioid treatments once they tested positive for illicit drugs?

Right. Among those who test positive, 90 percent continued to receive opioids, but, when you look among those who test positive for cocaine or marijuana, blacks are twice as like to have opioids discontinued if they test positive for marijuana and three times more likely to have opioids discontinued if they test positive for cocaine.   

Do you know what happened to these patients once their treatment was ended? 

We do not. That’s one of the limitations for this study. This was a review for about 15,000 medical records for patients receiving care at the VA. Because it was a review of the electronic medical records, we don’t know the circumstances behind why the treatment was discontinued and what happened to the patients going forward.   

And this goes back a ways. All the way back to 2000 and ending at 2010 in terms of the data you were able to use for research.   

Right, so we looked from 2000 to 2010. 

According to the Centers for Disease Control and Prevention, more than 40 percent of U.S. opioid deaths in 2016 involved a prescription opioid. In your study, you point out that efforts to curb this crisis on limiting overprescriptions, but less attention has been paid to how providers monitor and treat patients once they begin taking opioids. Why would monitoring the use of opioids be more effective?

Well, I think that just a clear understanding of who the patient is, whether they have a substance use disorder history, a history of mental illness, whether they’ve used illicit drugs in the past, and closely monitoring patients once treatment begins. 

We’ve looked before to see whether clinicians are adhering to these guidelines in terms of not only urine drug testing but also frequency of visits and assessments of mental illness and substance use disorder prior to starting treatment. And we found the vast majority of patients do not receive care in accordance with the clinical practice guidelines, which have been in place since the early 2000s.

The VA has their own guidelines which have been in place since 2003. So yes, I think that it’s important that overprescription is addressed, but it’s also important to monitor patients that are being prescribed opioids.  

What will you do with the information that you found? 

Well we hope that going forward clinicians will take the findings from this study and adhere to the guidelines from the CDC in particular with the recommendation to test all patients, at least initially and then at least annually thereafter starting treatment. 

Dr. Julie Gaither of Yale University, thank you for your time today, appreciate it.

Thank you.

Tom has been with WSHU since 1987, after spending 15 years at college and commercial radio and television stations. He became Program Director in 1999, and has been local host of NPR’s Morning Edition since 2000.