Racial disparities across provider specialties in opioid prescriptions dispensed to medicaid beneficiaries with chronic noncancer pain.
OBJECTIVE
Chronic pain affects both psychological and physical functioning, and is responsible for more than $60 billion in lost productivity annually in the United States. Although previous studies have demonstrated racial disparities in opioid treatment, there is little evidence regarding disparities in treatment of chronic noncancer pain (CNCP) and the role played by physician specialty in these disparities.


DESIGN
A retrospective cohort study.


SETTING
We analyzed North Carolina Medicaid claims data, from July 1, 2009 to May 31, 2010, to examine disparities by different provider specialties in beneficiaries' dispensed prescriptions for opioids.


SUBJECTS
The population included white and black North Carolina Medicaid beneficiaries with CNCP (N = 75,458).


METHODS
We used bivariate statistics and logistic regression analysis to examine race-based discrepancies in opioid prescribing by physician specialty.


RESULTS
Compared with white beneficiaries with CNCP (N = 49,197), black beneficiaries (N = 26,261) were less likely (odds ratio [OR] 0.91 [confidence interval {CI}: 0.88-0.94]) to fill an opioid prescription. Our hypothesis was partially supported: we found that race-based differences in beneficiaries' dispensed opioid prescriptions were more prominent in certain specialties. In particular, these differences were most salient among patients of specialists in obstetrics and gynecology (OR 0.78 [CI: 0.67-0.89]) and internal medicine (OR 0.86 [CI: 0.79-0.92]), as well as general practitioners/family medicine physicians (OR 0.91 [CI: 0.85-0.97]).


CONCLUSIONS
Our findings suggest that, in our study population, black beneficiaries with CNCP are less likely than whites to fill prescriptions for opioid analgesics as a function of their provider's specialty. Although race-based differences in patients filling opioid prescriptions have been noted in previous studies, this is the first study that clearly demonstrates these disparities by provider specialty.
['Ringwalt|Chris|C|', 'Roberts|Andrew W|AW|', 'Gugelmann|Hallam|H|', 'Skinner|Asheley Cockrell|AC|']
D000293:Adolescent D000328:Adult D001741:African Americans D000701:Analgesics, Opioid D059350:Chronic Pain D015331:Cohort Studies D003695:Delivery of Health Care D005260:Female D006801:Humans D008297:Male D008484:Medicaid D008875:Middle Aged D059408:Pain Management D010818:Practice Patterns, Physicians' D012189:Retrospective Studies D014481:United States D044465:Whites D055815:Young Adult
Opioids Prescriptions Chronic Pain Primary Care