African Americans With Cancer Pain Are More Likely to Receive an Analgesic With Toxic Metabolite Despite Clinical Risks: A Mediation Analysis Study

Purpose Renal impairment is highly prevalent among patients with cancer, and many patients have undiagnosed chronic kidney disease (CKD) from underlying disease, treatment, or both. African American individuals have disproportionate risk factors (diabetes, hypertension) predisposing them to CKD. We investigated whether African American patients are more likely than white patients to receive morphine with 3- and 6-glucuronide metabolites, which are known to be neurotoxic and accumulate in CKD; whether insurance type mediates the relationship between race and the prescriber's opioid selection; and whether the chosen opioid has a resultant negative effect according to race. Patients and Methods Patients (N = 182) were recruited from oncology clinics within the University of Pennsylvania Health System. Inclusion was based on self-identified African American or white race, age older than 18 years, and the presence of cancer-related pain plus a prescription for morphine or oxycodone. Kidney function was estimated using the abbreviated Modification of Diet in Renal Disease formula. Results Patients with CKD who received morphine reported a greater severity of analgesic-related adverse effects than patients with CKD who received oxycodone (P = .010). Controlling for health insurance type, African American patients had 71% lower odds of receiving a prescription of oxycodone than white patients (P < .001). Limiting analysis to those with CKD, the effect of private insurance became insignificant. However, race still remained a significant predictor of the prescribed opioid selection. Race was a strong predictor of adverse effect severity in the presence of CKD, and the type of opioid selection partially mediated this relationship. Conclusion Reducing racial disparities in the type of opioid prescription and understanding mechanisms of disproportionate opioid-related adverse effects in African American patients might decrease the clinical disparities in cancer pain outcomes.

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Trends in Postoperative Opioid Prescribing in Outpatient Pediatric Surgery

Pain Medicine ◽

10.1093/pm/pny284 ◽

2019 ◽

Vol 20 (9) ◽

pp. 1789-1795

Author(s):

Gabrielle C Donohoe ◽

Bingqing Zhang ◽

Janell L Mensinger ◽

Ronald S Litman

Keyword(s):

Incidence Rate ◽

Outpatient Surgery ◽

Private Insurance ◽

Duration Of Treatment ◽

Opioid Prescription ◽

Opioid Prescribing ◽

Dose Number ◽

Race Ethnicity ◽

To Receive ◽

Directional Trend

Abstract Objective To determine trends in opioid prescribing for home use after pediatric outpatient surgery. Design Retrospective analysis of a de-identified database. Setting Multispecialty children’s hospital and freestanding surgery centers. Patients, Participants A total of 65,190 encounters of pediatric outpatient surgeries from 2013 through 2017 for nine different surgical specialties. Patients in the cardiothoracic service and nonpainful procedures were excluded. Main Outcome Measures. Incidence rate of prescribing, dose, number of doses available (i.e., duration of therapy), and maximum weight-based home opioid availability from 2013 to 2017. Additional independent variables included sex, age, weight, race/ethnicity, insurance type (private vs public), and surgical service. Results The incidence rate of receiving a take-home opioid prescription at discharge ranged from 18% to 21% between 2013 and 2017, with no clear directional trend. Among patients prescribed opioids, however, the maximum available take-home dose steadily declined from 2013 through 2017 (P < 0.001). This was due to both a decrease in the number of doses prescribed (i.e., duration of treatment) and, beginning in 2015, the amount per dose. Females were more likely to receive an opioid than males, and patients with public insurance were more likely to receive an opioid than those with private insurance. Opioid prescribing was more likely in patients who did not disclose their ethnicity and those of ethnic minority compared with white patients (all P < 0.0001). Conclusions The rate of receiving a take-home opioid prescription and the dose prescribed remained stable from 2013 to 2017, but the duration of treatment steadily declined, and beginning in 2015, the amount per dose also decreased. Certain subgroups of patients were more likely to be prescribed opioids and will require further investigation and confirmation.

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Interns’ Attitudes on Cancer Pain and Its Management

Songklanagarind Medical Journal ◽

10.31584/smj.2017.35.3.735 ◽

2017 ◽

Vol 35 (3) ◽

pp. 255

Author(s):

Sasikaan Nimmaanrat ◽

Chatchai Prechawai ◽

Maliwan Oofuvong

Keyword(s):

Cancer Pain ◽

Clinical Judgment ◽

Low Dose ◽

Morphine Injection ◽

Negative Attitudes ◽

Opioid Prescription ◽

Analgesic Treatment ◽

Pain Medications ◽

To Receive ◽

Pain Patients

Objective: This study was designed to evaluate interns’ attitudes in terms of cancer pain and its management, including opioid prescription.Material and Method: Questionnaires consisting of 2 parts (attitudes toward cancer pain and its management as well as attitudes toward opioid prescription), were completed by 125 out of 165 interns (75.8%).Result: The majority of them thought that maximum analgesic treatment should be commenced when patients’ life expectancy was not more than 1 year (76.0%). They rated the patients’ requirement for pain medications as average (73.6%) and supposed that the demand for higher analgesic doses indicating increased pain level (60.8%). Almost seventy percent would cautiously regulate the dosage and frequency of opioids to avoid tolerance and addiction. Two thirds did not agree to provide too low dose of opioid to prevent tolerance. Over 80.0% did not agree that they should inform patients, as well as their relatives, that opioids were bad, nor did they reassure them that trying to bear pain may be a better alternative. Over half would discourage patients who were willing to stand the pain and refused to receive a morphine injection. None strongly agreed not to prescribe opioids due to a fear of respiratory depression.Conclusion: Although the minority of the participated interns had negative attitudes towards cancer pain and its management, these negative attitudes may influence their clinical judgment and practice, which lead to inadequate pain management being provided to cancer pain patients, who are in need for optimal pain relief.

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Impact of Cannabis Use on Least Pain Scores Among African American and White Patients with Cancer Pain: A Moderation Analysis

Journal of Pain Research ◽

10.2147/jpr.s332447 ◽

2021 ◽

Vol Volume 14 ◽

pp. 3493-3502

Author(s):

Salimah H Meghani ◽

Ryan Quinn ◽

Rebecca Ashare ◽

Kristin Levoy ◽

Brooke Worster ◽

...

Keyword(s):

African American ◽

Cancer Pain ◽

Cannabis Use ◽

Moderation Analysis ◽

Patients With Cancer ◽

Pain Scores ◽

White Patients

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Racial and Ethnic Disparities in Discharge Opioid Prescribing From a Hospital Medicine Service

Journal of Hospital Medicine ◽

10.12788/jhm.3667 ◽

2021 ◽

Vol September 2021 - Online First ◽

Author(s):

Aksharananda Rambachan ◽

Margaret C Fang ◽

Priya Prasad ◽

Nicholas Iverson

Keyword(s):

General Medicine ◽

Prescribing Patterns ◽

Opioid Prescription ◽

Opioid Prescribing ◽

Asian Patients ◽

Medicine Service ◽

Black Patients ◽

To Receive ◽

Population Rate ◽

White Patients

BACKGROUND: Differential opioid prescribing patterns have been reported in non-White patient populations. However, these disparities have not been well described among hospitalized medical inpatients. OBJECTIVE: To describe differences in opioid prescribing patterns among inpatients discharged from the general medicine service based on race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS: For this retrospective study, we performed a multivariable logistic regression for patient race/ethnicity and whether patients received an opioid prescription at discharge and a negative binomial regression for days of opioids prescribed at discharge. The study included all 10,953 inpatients discharged from the general medicine service from June 2012 to November 2018 at University of California San Francisco Medical Center who received opioids during the last 24 hours of their hospitalization. MAIN OUTCOMES AND MEASURES: We examined two primary outcomes: whether a patient received an opioid prescription at discharge, and, for patients prescribed opioids, the number of days dispensed. RESULTS: Compared with White patients, Black patients were less likely to receive an opioid prescription at discharge (predicted population rate of 47.6% vs 50.7%; average marginal effect [AME], −3.1%; 95% CI, −5.5% to −0.8%). Asian patients were more likely to receive an opioid prescription on discharge (predicted population rate, 55.6% vs 50.7%; AME, +4.9; 95% CI, 1.5%-8.3%). We also found that Black patients received a shorter duration of opioid days compared with White patients (predicted days of opioids on discharge, 15.7 days vs 17.8 days; AME, −2.1 days; 95% CI, −3.3 to −0.9). CONCLUSION: Black patients were less likely to receive opioids and received shorter courses at discharge compared with White patients, adjusting for covariates. Asian patients were the most likely to receive an opioid prescription.

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Utilization of epilepsy surgery in the United States: A study of the National Inpatient Sample investigating the roles of race, socioeconomic status, and insurance

Surgical Neurology International ◽

10.25259/sni_824_2021 ◽

2021 ◽

Vol 12 ◽

pp. 546

Author(s):

Jacob Bernstein ◽

Samir Kashyap ◽

Michael W. Kortz ◽

Bishoy Zakhary ◽

Ariel Takayanagi ◽

...

Keyword(s):

Socioeconomic Status ◽

Epilepsy Surgery ◽

Surgical Procedure ◽

Private Insurance ◽

The United States ◽

Cross Sectional ◽

Black Patients ◽

To Receive ◽

Income Quartile ◽

White Patients

Background: Epilepsy is estimated to affect 70 million people worldwide and is medically refractory in 30% of cases. Methods: This is a retrospective cross-sectional study using a US database from 2012 to 2014 to identify patients aged ≥18 years admitted to the hospital with epilepsy as the primary diagnosis. The sampled population was weighted using Healthcare Cost and Utilization Project guidelines. Procedural ICD-9 codes were utilized to stratify the sampled population into two cohorts: resective surgery and implantation or stimulation procedure. Results: Query of the database yielded 152,925 inpatients, of which 8535 patients underwent surgical intervention. The nonprocedural group consisted of 76,000 White patients (52.6%) and 28,390 Black patients (19.7%) while the procedural group comprised 5550 White patients (64%) and 730 Black patients (8.6%) (P < 0.001). Patients with Medicare were half as likely to receive a surgical procedure (14.8% vs. 28.4%) while patients with private insurance were twice as likely to receive a procedure (53.4% vs. 29.3%), both were statistically significant (P < 0.01). Those in the lowest median household income quartile by zip code (<$40,000) were 68% less likely to receive a procedure (21.5% vs. 31.4%) while the highest income quartile was 133% more likely to receive a procedure (26.1% vs. 19.5%). Patients from rural and urban nonteaching hospitals were, by a wide margin, less likely to receive a surgical procedure. Conclusion: We demonstrate an area of need and significant improvement at institutions that have the resources and capability to perform epilepsy surgery. The data show that institutions may not be performing enough epilepsy surgery as a result of racial and socioeconomic bias. Admissions for epilepsy continue to increase without a similar trend for epilepsy surgery despite its documented effectiveness. Race, socioeconomic status, and insurance all represent significant barriers in access to epilepsy surgery. The barriers can be remedied by improving referral patterns and implementing cost-effective measures to improve inpatient epilepsy services in rural and nonteaching hospitals.

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Postgraduate education and years of medical practice affect rate of opioid-prescription among physicians treating cancer pain

Journal of Pain and Symptom Management ◽

10.1016/s0885-3924(98)80056-0 ◽

1998 ◽

Vol 15 (4) ◽

pp. S17

Author(s):

M Bautz

Keyword(s):

Cancer Pain ◽

Medical Practice ◽

Postgraduate Education ◽

Opioid Prescription

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African American patients with surgically managed ectopic pregnancy are less likely than white patients to be offered salpingostomy

Fertility and Sterility ◽

10.1016/j.fertnstert.2018.07.768 ◽

2018 ◽

Vol 110 (4) ◽

pp. e270-e271

Author(s):

J.A. Gingold ◽

I. Janmey ◽

L. Gemmell ◽

L.D. Bradley ◽

T. Falcone

Keyword(s):

African American ◽

Ectopic Pregnancy ◽

White Patients

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Sex, Race, Insurance, and Pain: Do Patient Sociodemographics Influence Postoperative Opioid Prescriptions Among Hand Surgeons?

Hand ◽

10.1177/1558944721998020 ◽

2021 ◽

pp. 155894472199802

Author(s):

Connor J. Peck ◽

Martin Carney ◽

Alexander Chiu ◽

Kitae E. Park ◽

Alexandre Prassinos ◽

...

Keyword(s):

Chronic Pain ◽

Medical Center ◽

Carpal Tunnel Release ◽

Private Insurance ◽

Academic Medical Center ◽

Age Groups ◽

Postoperative Pain Management ◽

Patient Treatment ◽

Opioid Prescription ◽

History Of

Background: Social and demographic factors may influence patient treatment by physicians. This study analyzes the influence of patient sociodemographics on prescription practices among hand surgeons. Methods: We performed a retrospective analysis of all hand surgeries (N = 5278) at a single academic medical center from January 2016 to September 2018. The average morphine milligram equivalent (MME) prescribed following each surgery was calculated and then classified by age, race, sex, type of insurance, and history of substance use or chronic pain. Multivariate linear regression was used to compare MME among groups. Results: Overall, patients with a history of substance abuse were prescribed 31.2 MME more than those without ( P < .0001), and patients with a history of chronic pain were prescribed 36.7 MME more than those without ( P < .0001). After adjusting for these variables and the type of procedure performed, women were prescribed 11.2 MME less than men ( P = .0048), and Hispanics were prescribed 16.6 MME more than whites ( P = .0091) overall. Both Hispanic and black patients were also prescribed more than whites following carpal tunnel release (+19.0 and + 20.0 MME, respectively; P < .001). Patients with private insurance were prescribed 24.5 MME more than those with Medicare ( P < .0001), but 25.0 MME less than those with Medicaid ( P < .0001). There were no differences across age groups. Conclusions: Numerous sociodemographic factors influenced postoperative opioid prescription among hand surgeons at our institution. These findings highlight the importance of establishing more uniform, evidence-based guidelines for postoperative pain management, which may help minimize subjectivity and prevent the overtreatment or undertreatment of pain in certain patient populations.

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