Opioid Dose Reductions by Sex and Race in a Cohort of Patients in a Family Medicine Clinic

Department

Graduate Medical Education

Document Type

Article

Publication Title

Journal of the American Board of Family Medicine : JABFM

Abstract

Background: The 2022 Centers for Disease Control's "Clinical Practice Guidelines for Prescribing Opioids for Pain in United States" called for attention and action toward reducing disparities in untreated and undertreated pain among Black and Latino patients. There is growing evidence for controlled substance safety committees (CSSC) to change prescribing culture, but few have been examined through the lens of health equity. We examined the impact of a primary care CSSC on opioid prescribing, including by patients' race and sex.

Methods: We conducted a retrospective cohort study. Our primary outcome was a change in prescribed morphine milligram equivalents (MME) at baseline (2017) and follow-up (2021). We compared the differences in MME by race and sex. We also examined potential intersectional disparities. We used paired t test to compare changes in mean MME's and logistic regression to determine associations between patient characteristics and MME changes.

Results: Our cohort included 93 patients. The mean opioid dose decreased from nearly 200 MME to 136.1 MME, P < .0001. Thirty percent of patients had their dose reduced to under 90 MME by follow-up. The reduction rates by race or sex alone were not statistically significant. There was evidence of intersectional disparities at baseline. Black women were prescribed 88.5 fewer MME's at baseline compared with their White men counterparts, P = .04.

Discussion: Our findings add to the previously documented success of CSSCs in reducing opioid doses for chronic nonmalignant pain to safer levels. We highlight an opportunity for primary care based CSSCs to lead the efforts to identify and address chronic pain management inequities.

First Page

383

Last Page

388

DOI

10.3122/jabfm.2023.230220R2

Volume

37

Issue

3

Publication Date

8-14-2024

Medical Subject Headings

Humans; Analgesics, Opioid (administration & dosage, therapeutic use); Male; Female; Retrospective Studies; Middle Aged; Family Practice; Practice Patterns, Physicians' (statistics & numerical data); Adult; Sex Factors; Healthcare Disparities (statistics & numerical data, ethnology); Chronic Pain (drug therapy); United States; Hispanic or Latino (statistics & numerical data); Aged; Primary Health Care; Black or African American (statistics & numerical data)

PubMed ID

38942449

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