Patient Preference and Risk Assessment in Opioid Prescribing Disparities

While racial disparities in acute pain control are well documented, the role of patient analgesic preference and the factors associated with such disparities have yet to be fully explored. As such, this study, featuring PISC Senior Scholar Shoshana Aronowitz, PhD, CRNP, and Executive Committee member Zachary F. Meisel, MD, MPH, MA, aimed to test the hypothesis that racial disparities may be mitigated by giving clinicians additional information about their patients' treatment preferences and risk of opioid misuse. The study first analyzed data collected from Life STORRIED (Life Stories for Opioid Risk Reduction in the ED), a multicenter randomized clinical trial conducted between June 2017 and August 2019 in the emergency departments (EDs) of 4 academic medical centers. Then the treatment arm was randomized to receive a patient-facing intervention and a clinician-facing intervention that consisted of a form containing information about each patient's analgesic treatment preference and risk of opioid misuse. The study found that after controlling for demographic characteristics and clinical features, Black patients had lower odds than White patients of receiving a prescription for opioid medication at ED discharge. When patients who did and did not prefer opioids were considered separately, Black patients continued to have lower odds of being discharged with a prescription for opioids compared with White patients. These disparities were not eliminated in the treatment arm, suggesting that a lack of patient information may not be associated with opioid prescribing disparities.

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