Racial inequities in U.S. naloxone prescriptions

Abstract

Background: Research indicates U.S. racial and ethnic minority patients are prescribed opioids for pain less often than non-Hispanic Whites. Racial inequities are strongest for pain conditions with uncertain prognosis (e.g., chronic pain syndrome) compared to acute pain with defined duration (e.g., fractures). As naloxone, an opioid overdose reversal drug, becomes more popular among prescribers in clinical contexts, it is unclear whether racial inequities also extend to naloxone prescriptions. Methods: Patients diagnosed with bone fracture (n = 551,103) or chronic pain syndrome [CPS] (n = 173,341) were identified using ICD-9 and ICD-10 codes in electronic health records from the Health Facts® Database. Logistic regressions were used to determine whether the likelihood of receiving a prescription for opioids or a co-prescription for opioids and naloxone differ by patient race/ethnicity, which included African American, Native American, Non-Hispanic White, Asian/Pacific Islander, Hispanic, and “other” categories. Results: Multiple logistic regressions show naloxone prescriptions do not consistently mirror trends in opioid prescriptions when broken down by patient race/ethnicity and diagnosis. Patients of color with bone fracture or CPS are largely less likely to receive prescriptions for outpatient opioid analgesics than their non-Hispanic White counterparts. Among bone fracture patients prescribed opioids, African Americans and patients of “other” race/ethnicity are also significantly less likely to receive naloxone prescriptions. However, Native American and Hispanic CPS patients prescribed opioids are more likely to get naloxone prescriptions despite being less likely to get opioid prescriptions. And while Native American and Asian/Pacific Islander fracture patients and “other” race/ethnicity CPS patients are less likely to receive an opioid prescription than non-Hispanic Whites, there is no difference from non-Hispanic Whites in their likelihood of receiving a naloxone prescription. Conclusions: Among patients prescribed opioids, naloxone prescriptions vary by patient race/ethnicity and by health condition, indicating the need for efforts to assure equitable diffusion of this harm reduction intervention.

Keywords:

• Naloxone
• race/ethnicity
• health service inequities
• overdose
• opioids

Acknowledgments

We would like to thank Harry Snow for assistance with obtaining data, Yazan K. Barqawi, PharmD for help with NDCs, William Tierney, MD and Nina Wallerstein, DrPH for comments on early drafts, and for the valuable feedback from the reviewers and editors. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Research was approved by the University of New Mexico Human Research Protections Office. The authors have no conflicts of interest to disclose.

Contributions

Dr. Madden developed the research question, managed NDC and ICD coding, assisted Dr. Qeadan with cleaning data and analysis, and wrote the introduction, results, and discussion sections of the manuscript. Dr. Qeadan led the data cleaning, coded the analysis, collaborated with Dr. Madden in creating the analysis, wrote the methods section, and provided substantive comments on all drafts of the writing.

Additional information

Funding

This research was made possible by the Mountain West Clinical Translational Research Infrastructure Network (CTRIN) [grant 1U54GM104944] and UNM Clinical & Translational Science Center (CTSC) [grant UL1TR001449], University of New Mexico Health Sciences Center, Albuquerque, New Mexico.