Black opioid pain patients get tested more frequently than whites for illicit drug use, study shows
Clinicians are more likely to test black patients receiving opioid therapy for illicit drug use than white patients and are quicker to discontinue their opioid treatments when they test positive, according to a new study.
Black patients were more than twice as likely as white patients to undergo testing for illicit drug use in the months after starting opioid therapy, even though whites are at higher risk of overdose and death from opioids than any racial group, according to a study by Yale University published Monday in the journal Drug and Alcohol Dependence.
The Centers for Disease Control and Prevention in 2016 recommended testing long-term opioid patients' urine at least once a year and assessing whether they may be using other controlled prescription drugs or illicit drugs.
Yale researchers examined electronic health records from more than 15,000 patients who received opioids from the Veterans Health Administration between 2000 and 2010 to treat chronic pain. Only 20% of patients on opioid therapy were tested for illicit drug use, and of those tested, 14% tested positive for cannabis and 17% tested positive for cocaine.
If patients are using illicit drugs, the CDC calls on clinicians to discontinue or taper off their opioid prescriptions, conduct more frequent evaluations, refer them to substance use disorder treatment or change their pain management approach.
Researchers found clinicians discontinued opioid therapy in only 11% of patients who tested positive for marijuana and in 13% who tested positive for cocaine. But black patients were more than twice as likely than white patients to have their opioid treatment discontinued when they tested positive for marijuana, and more than three times more likely to get cut off when testing positive for cocaine.
There isn't clear guidance for how clinicians should treat opioid patients after they discover they're using illicit drugs, according to study lead author Julie Gaither, an instructor of general pediatrics at Yale School of Medicine. Some clinicians may rely on implicit biases and racial stereotypes to make their treatment decisions.
"We believe something that could possibly explain these findings is that without real clear guidance on how to respond, physicians are relying on subjective measures and maybe taking into account extraneous factors including race," Gaither said. "With that there's the potential to make errors in judgment and to discriminate based on race."
Gaither called for providers to take a more universal approach both toward testing patients and responding to positive tests.
"There's no mandate that says that if the patient tests positive for illicit drug use that they should automatically be discontinued," Gaither said.
The study's findings reflect other evidence amassed over the years that points to inequities in pain treatment based on race.
Such differences have contributed to an opioid epidemic that has disproportionately affected white Americans more than any other racial group, accounting for 79% of all opioid-related drug overdose deaths in 2016 compared to 10% of blacks and 8% among Latinos, according to the Kaiser Family Foundation.
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