Impacts of social determinants of health on chronic opioid therapy for chronic non-cancer pain

Abstract

Aim: We aimed to investigate the association between social determinants of health and chronic opioid therapy. Materials & methods: We conducted a retrospective analysis of electronic health records from five family medicine and internal medicine clinics in Oregon in 2020 and 2021. Our outcome variable was whether a patient was receiving chronic opioid therapy for chronic non-cancer pain. Our variables of interest included financial difficulty, insurance types, transportation barriers, currently married or living with a partner and organizations participation. Results: Our results showed that patients with financial difficulty were more likely to have chronic opioid therapy (OR: 2.69; 95% CI: 1.14, 6.33). Conclusion: Addressing patients’ social determinants of health disadvantages is important for optimizing pain management.

Plain language summary

What is this article about?

Addressing the opioid crisis is a national priority in the USA. Our objective was to focus on a broad set of social determinants of health (SDOH) and examine whether patients with SDOH disadvantages were more likely to receive chronic opioid therapy for chronic non-cancer pain. Current literature has not assessed some important SDOH characteristics. We aimed to address this limitation by using electronic health records that incorporated SDOH data.

What were the results?

Patients with financial difficulty in this study had approximately two-times higher odds of receiving chronic opioid therapy.

What do the results of the study mean?

Our study has important clinical and policy implications. Clinicians should screen for patient SDOH disadvantages and provide support as an integral part of patient-centered pain management. Payers and policymakers should also consider expanding coverage and reimbursement for multimodal treatments for pain.

Article highlights

• Addressing the opioid crisis is a national priority in the USA.

• Literature suggests that opioid therapy is associated with higher risks of opioid overdose and misuse, and therefore a key solution to the opioid crisis is to reduce chronic opioid therapy.

• Early research has not assessed some important social determinants of health (SDOH) that could affect pain management.

• Our current study tested a hypothesis that patients with SDOH disadvantages were more likely to receive chronic opioid therapy for chronic non-cancer pain.

• We used electronic health records incorporated with patient-reported data to examine a broader set of SDOH measures.

• Patients with financial difficulty in our study had significantly higher odds of receiving chronic opioid therapy.

• It is important to increase coverage and reimbursement for nonopioid treatment options to mitigate the risks associated with chronic opioid use.

• Clinicians' time and efforts to screen for patients’ SDOH disadvantages should also be appropriately reimbursed.

Keywords: :

• chronic pain
• electronic health records
• financial difficulty
• opioid therapy
• patient-centered care
• social determinants of health

Acknowledgments

We thank Paulina Kaiser at Samaritan Health Outcomes Research & Evaluation for support.

Author contributions

Each author contributed substantive research, writing, editing and approved the manuscript.

Financial disclosure

This work was supported by the Good Samaritan Hospital Foundation John C. Erkkila, M.D. Endowment for Health and Human Performance. The content in this article is solely the responsibility of the authors. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

We requested a waiver of consent because our study meet criteria below: The research involves no more than minimal risk; and the waiver or alteration will not adversely affect the rights and welfare of the subjects; and the research could not practicably be carried out without the waiver or alteration; and whenever appropriate, the subjects will be provided with additional pertinent information after participation. Our study was approved by the Institutional Review Boards at Samaritan Health Services (IRB21-067) and Oregon State University (HE-2023-329).

Previous presentation

Preliminary findings from this study have been presented at: American Society of Anesthesiologists Annual Meeting, October 2023, San Francisco, California, USA (poster abstract not published).

Additional information

Funding

This work was supported by the Good Samaritan Hospital Foundation John C. Erkkila, M.D. Endowment for Health and Human Performance. The content in this article is solely the responsibility of the authors.