Racial Disparities in Unmet Pain Treatment Preference, Pain Treatment Satisfaction and Subsequent Opioid Misuse: A Secondary Analysis of a National Multisite RCT.

Background: Racial disparities in opioid prescriptions for pain are well documented. Evidence shows undertreated acute pain increases the risk of developing chronic pain, which puts patients at risk of long-term opioid use and misuse. We sought to determine the association between satisfaction with analgesia, unmet opioid preference, and opioid misuse risk by race in a diverse, longitudinal cohort.

Methods: We conducted a secondary analysis of participants with complete data in an RCT of 1301 patients who presented to the emergency department (E.D.) for acute kidney or back pain. Our primary outcome was opioid misuse risk quantified by the current opioid misuse measure (COMM), a self-report 17-item measure of risk of aberrant medication-related behavior among persons prescribed opioids for chronic pain, measured 90 days after the index E.D. visit. We used descriptive statistics and linear regressions to determine associations between satisfaction with analgesia (1-10, measured 1-day post-visit), unmet opioid preference, and opioid misuse risk by race, adjusting for age and sex.

Results: We analyzed 735 participants. The mean (SD) age was 39.6 (13.6), 58.9% (n = 432) were female, 46.4%(n = 341) were White, and 36.9%(n = 271) were Black. Unmet preference was more common among Black (21.8%, n = 59) vs. White (15%, n = 51) participants. Black (vs White) participants had a higher median (IQR) COMM (4 (1 - 12) vs 3 (1 - 6), P < 0.001, and lower median satisfaction (7 (4-10) vs 8 (5 - 10), P = 0.002). Adjusting for unmet preference and satisfaction, Black (vs. White) participants had higher COMM (β = 3.4, 95% CI 1.6-5.3, P = 0.01). Unmet preference was associated with higher COMM (β = 2.3, 95% CI 1.3-3.2, P < 0.001). Satisfaction was associated with lower COMM (β = - 0.5 pp, 95% CI - 0.7, - 0.2, P < 0.01). In a model with a triple interaction between satisfaction, unmet preference, and race, satisfaction was associated with lower COMM (- 0.3 pp, 95% CI - 0.5, - 0.1, P = 0.03) and mitigated the effect of unmet preference on Black participants' COMM (marginal effect β = - 1.3 pp, 95% CI - 1.9, - 0.7, P = 0.01).

Conclusion: Satisfaction with analgesia was protective against opioid misuse risk, especially among Black participants whose opioid preference was unmet. Addressing unmet preferences and understanding factors that shape patient satisfaction with analgesia could help reduce racial disparities in opioid misuse.