Drivers of Opioid Prescriptions for Medicare Patients at an Urban Tertiary Center.

Introduction: Froedtert & the Medical College of Wisconsin belongs to a minority of institutions in which opioids are more frequently prescribed to non-Hispanic Black patients than their non-Hispanic White counterparts. The objective of this study was to evaluate racial and ethnic differences in prescribing practices for Medicare patients to determine areas for intervention.

Methods: This was a retrospective review of adult patients with Medicare insurance who received an ambulatory opioid prescription for pain. Outcomes included number of prescriptions, and maximum morphine milligram equivalent (MME). Unadjusted and adjusted linear regression models were used to examine associations between race and ethnicity and each outcome with and without adjustments for covariates.

Results: A total of 17 105 patients were given an ambulatory opioid prescription over the study period. Although most prescriptions were provided to non-Hispanic White patients, non-Hispanic Black patients had a higher mean number of prescriptions (4.36; 95% CI, 4.08 - 4.63) and higher MMEs at 495.31 (95% CI , 445.72 - 544.91). After controlling for demographics and comorbidities, individual comorbidities emerged as independent variables associated with greater numbers of prescriptions, with sickle cell disease (β 9.86; 95% CI, 9.08-10.64; PP <  0.001), drug abuse (β 5.22; 95% CI, 4.96-5.48; PP < 0.001), and paralysis (β 2.20; 95% CI, 1.73-2.67; PP <0.001) having the strongest relationships, while after adjustment, the significance of race and ethnicity was lost.

Conclusions: Institutions should explore reasons for racially inequitable opioid receipt. Individual comorbidities were associated with differences in opioid prescribing, allowing for targeted interventions in these patient groups.