Patient preferences do not explain racial disparities in opioid prescribing

Why are Black patients less likely than white patients to be prescribed opioids for acute pain in the emergency department? While many theories have been put forward—ranging from racial differences in patients’ pain management preferences to providers’ false beliefs in biological differences between racial groups—the specific mechanisms underpinning these disparities are unclear.

Zachary Meisel, associate professor in emergency medicine in the Perelman School of Medicine and senior fellow at the Leonard Davis Institute of Health Economics, and medical student Eden Engel-Rebitzer, used data collected for Life STORRIED, a multicenter randomized controlled trial (RCT) to clarify the role of patient pain management preference and to test the effectiveness of an intervention in reducing these disparities. 

hospital emergency room sign

Researchers studied 1,302 patients presenting to the emergency departments (ED) of four academic medical centers with acute musculoskeletal back pain or renal colic. Even in the controlled setting of an RCT, they found that Black patients presenting to the ED were less than half as likely as similar white patients to be prescribed opioids for acute pain.

Patient preferences did not seem to explain this disparity. Researchers found nearly identical disparities among patients who preferred opioids and among those who did not prefer opioids. Even among patients who preferred to not receive opioids, white patients were more likely than Black patients to be prescribed opioids.

This story is by Eden Engel-Rebitzer and Zachary Meisel. Read more at Penn LDI.