People of color less likely to receive opioids for lower back pain, study finds

Sept. 10 (UPI) -- People of color with lower back pain are less likely than White people to receive prescription opioid pain medications from their physicians, a study published Friday by JAMA Health Forum found.

On average, between 2007 and 2014, 12% of White patients included in the analysis were given a prescription for an opioid pain reliever during their first year with lower back pain, the data showed.

In comparison, over the same period, about 11% of Hispanic patients, 10% of Black patients and 9% of Asian or Pacific Islander patients were prescribed the drugs in their first year of lower back pain, the researchers said.

During the period covered by the analysis "less was known" about the potential risks associated with prescription opioid use, including addiction, the researchers said.

The study findings suggest "that there may have been unequal treatment of pain" based on race, at a time when these drugs were considered the most effective treatment for pain, they said.

"At the height of the opioid epidemic, when the dangers of opioids weren't as well-known as they are today, physicians appeared to treat the pain of their minority patients differently than the pain of their White patients," study co-author Dr. Dan P. Ly told UPI in an email.

"I worry and suspect that physicians took the pain of their White patients more seriously or the pain of their minority patients less seriously, or physicians thought that their white patients were less likely to misuse opioids," said Ly, an assistant professor of internal medicine at UCLA.

Drug overdose deaths rose by 30% in the United States in 2020, due largely to the misuse and abuse of opioid pain medications.

Research shows that prescription opioids are addictive, and that they have been overused in the treatment of pain conditions, according to the National Institute on Drug Abuse.

As a result, in recent years, many professional societies, including the American Academy of Pain Medicine, have issued guidelines designed to limit inappropriate opioid prescribing, particularly for chronic pain conditions such as lower back pain.

However, they believe the drugs should still be used in cases in which patient pain does not respond to other therapies.

For this study, Ly and his colleagues reviewed the patient records of nearly 275,000 adult patients in the United States treated for new lower back pain by more than 63,000 physicians between 2007 and 2014.

Of the patients included in the analysis, 81% were White, 8% were Hispanic, 6% were Black and 6% were Asian or Pacific Islander.

Many physicians included in the analysis were more likely to prescribe an opioid alternative, such as a non-steroidal anti-inflammatory drug, or NSAID, to a patient of a racial or ethnic minority group than a White patient, the data showed.

Between 25% and 30% of patients of color received a prescription for an NSAID for new lower back pain, compared to about 23% of White patients, the researchers said.

Conversely, while nearly 12% of White patients were given a prescription opioid pain reliever, these options were offered to people of color less than 11% of the time.

Among patients with severe or longer-lasting pain, as measured by making five or more visits per year to their physicians, 36% of White patients received opioids compared to about 30% of Black patients, 21% of Asian or Pacific Islander patients and 24% of Hispanic patients.

Perhaps as a result, White patients with new lower back pain were more than three times as likely to use opioids for longer periods than patients of color, they said.

"The fact that, in hindsight, more white patients developed dangerous long-term opioid use doesn't absolve physicians of this differential treatment of pain," Ly said.