Utibe R Essien1,2, Florentina E Sileanu3, Xinhua Zhao3, Jane M Liebschutz4, Carolyn T Thorpe3,5, Chester B Good3,6, Maria K Mor3,7, Thomas R Radomski3,4, Leslie R M Hausmann3,4, Michael J Fine3,4, Walid F Gellad3,4. 1. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. utibe.essien@va.gov. 2. Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. utibe.essien@va.gov. 3. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. 4. Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 5. Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA. 6. Centers for Value-Based Pharmacy Initiatives and High-Value Health Care, UPMC Health Plan, Pittsburgh, PA, USA. 7. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Abstract
BACKGROUND: After non-fatal opioid overdoses, opioid prescribing patterns are often unchanged and the use of medications for opioid use disorder (MOUDs) remains low. Whether such prescribing differs by race/ethnicity remains unknown. OBJECTIVE: To assess the association of race/ethnicity with the prescribing of opioids and MOUDs after a non-fatal opioid overdose. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients prescribed ≥ 1 opioid from July 1, 2010, to September 30, 2015, with a non-fatal opioid overdose in the Veterans Health Administration (VA). MAIN MEASURES: Primary outcomes were the proportion of patients prescribed: (1) any opioid during the 30 days before and after overdose and (2) MOUDs within 30 days after overdose by race and ethnicity. We conducted difference-in-difference analyses using multivariable regression to assess whether the change in opioid prescribing from before to after overdose differed by race/ethnicity. We also used multivariable regression to test whether MOUD prescribing after overdose differed by race/ethnicity. KEY RESULTS: Among 16,210 patients with a non-fatal opioid overdose (81.2% were white, 14.3% black, and 4.5% Hispanic), 10,745 (66.3%) patients received an opioid prescription (67.1% white, 61.7% black, and 65.9% Hispanic; p < 0.01) before overdose. After overdose, the frequency of receiving opioids was reduced by 18.3, 16.4, and 20.6 percentage points in whites, blacks, and Hispanics, respectively, with no significant difference-in-difference in opioid prescribing by race/ethnicity (p = 0.23). After overdose, 526 (3.2%) patients received MOUDs (2.9% white, 4.6% black, and 5.5% Hispanic; p < 0.01). Blacks (adjusted OR (aOR) 1.6; 95% CI 1.2, 1.9) and Hispanics (aOR 1.8; 95% CI 1.2, 2.6) had significantly larger odds of receiving MOUDs than white patients. CONCLUSIONS: In a national cohort of patients with non-fatal opioid overdose in VA, there were no racial/ethnic differences in changes in opioid prescribing after overdose. Although blacks and Hispanics were more likely than white patients to receive MOUDs in the 30 days after overdose, less than 4% of all groups received such therapy.
BACKGROUND: After non-fatal opioid overdoses, opioid prescribing patterns are often unchanged and the use of medications for opioid use disorder (MOUDs) remains low. Whether such prescribing differs by race/ethnicity remains unknown. OBJECTIVE: To assess the association of race/ethnicity with the prescribing of opioids and MOUDs after a non-fatal opioid overdose. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients prescribed ≥ 1 opioid from July 1, 2010, to September 30, 2015, with a non-fatal opioid overdose in the Veterans Health Administration (VA). MAIN MEASURES: Primary outcomes were the proportion of patients prescribed: (1) any opioid during the 30 days before and after overdose and (2) MOUDs within 30 days after overdose by race and ethnicity. We conducted difference-in-difference analyses using multivariable regression to assess whether the change in opioid prescribing from before to after overdose differed by race/ethnicity. We also used multivariable regression to test whether MOUD prescribing after overdose differed by race/ethnicity. KEY RESULTS: Among 16,210 patients with a non-fatal opioid overdose (81.2% were white, 14.3% black, and 4.5% Hispanic), 10,745 (66.3%) patients received an opioid prescription (67.1% white, 61.7% black, and 65.9% Hispanic; p < 0.01) before overdose. After overdose, the frequency of receiving opioids was reduced by 18.3, 16.4, and 20.6 percentage points in whites, blacks, and Hispanics, respectively, with no significant difference-in-difference in opioid prescribing by race/ethnicity (p = 0.23). After overdose, 526 (3.2%) patients received MOUDs (2.9% white, 4.6% black, and 5.5% Hispanic; p < 0.01). Blacks (adjusted OR (aOR) 1.6; 95% CI 1.2, 1.9) and Hispanics (aOR 1.8; 95% CI 1.2, 2.6) had significantly larger odds of receiving MOUDs than white patients. CONCLUSIONS: In a national cohort of patients with non-fatal opioid overdose in VA, there were no racial/ethnic differences in changes in opioid prescribing after overdose. Although blacks and Hispanics were more likely than white patients to receive MOUDs in the 30 days after overdose, less than 4% of all groups received such therapy.
Authors: Marc R Larochelle; Dana Bernson; Thomas Land; Thomas J Stopka; Na Wang; Ziming Xuan; Sarah M Bagley; Jane M Liebschutz; Alexander Y Walley Journal: Ann Intern Med Date: 2018-06-19 Impact factor: 25.391
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Authors: Jessica J Wyse; Jonathan L Robbins; Kathleen A McGinnis; E Jennifer Edelman; Adam J Gordon; Ajay Manhapra; David A Fiellin; Brent A Moore; P Todd Korthuis; Julie R Gaither; Kirsha Gordon; Melissa Skanderson; Declan T Barry; Stephen Crystal; Amy Justice; Kevin L Kraemer Journal: Drug Alcohol Depend Date: 2019-03-09 Impact factor: 4.852
Authors: Carolyn T Thorpe; Walid F Gellad; Maria K Mor; John P Cashy; John R Pleis; Courtney H Van Houtven; Loren J Schleiden; Joseph T Hanlon; Joshua D Niznik; Ronald L Carico; Chester B Good; Joshua M Thorpe Journal: Health Serv Res Date: 2018-10-16 Impact factor: 3.734
Authors: Utibe R Essien; Nadejda Kim; Leslie R M Hausmann; Maria K Mor; Chester B Good; Jared W Magnani; Terrence M A Litam; Walid F Gellad; Michael J Fine Journal: JAMA Netw Open Date: 2021-07-01