Opioid and High-Risk Prescribing Among Racial and Ethnic Minority Veterans

Katie J Suda; Taylor L Boyer; John R Blosnich; John P Cashy; Colin C Hubbard; Lisa K Sharp

doi:10.1016/j.amepre.2023.06.008

Opioid and High-Risk Prescribing Among Racial and Ethnic Minority Veterans

Am J Prev Med. 2023 Nov;65(5):863-875. doi: 10.1016/j.amepre.2023.06.008. Epub 2023 Jun 10.

Authors

Katie J Suda¹, Taylor L Boyer², John R Blosnich³, John P Cashy², Colin C Hubbard⁴, Lisa K Sharp⁵

Affiliations

¹ Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address: ksuda@pitt.edu.
² Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
³ Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.
⁴ Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, California.
⁵ Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Illinois, Chicago.

PMID: 37302514
DOI: 10.1016/j.amepre.2023.06.008

Abstract

Introduction: The purpose of this study is to compare opioid prescribing and high-risk prescribing by race and ethnicity in a national cohort of U.S. veterans.

Methods: A cross-sectional analysis of veteran characteristics and healthcare use was performed on electronic health record data for 2018 Veterans Health Administration users and enrollees in 2022.

Results: Overall, 14.8% received an opioid prescription. The adjusted odds of being prescribed an opioid were lower for all race/ethnicity groups than for non-Hispanic White veterans, except for non-Hispanic multiracial (AOR=1.03; 95% CI=0.999, 1.05) and non-Hispanic American Indian/Alaska Native (AOR=1.06; 95% CI=1.03, 1.09) veterans. The odds of any day of overlapping opioid prescriptions (i.e., opioid overlap) were lower for all race/ethnicity groups than for the non-Hispanic White group, except for the non-Hispanic American Indian/Alaska Native group (AOR=1.01; 95% CI=0.96, 1.07). Similarly, all race/ethnicity groups had lower odds of any day of daily dose >120 morphine milligram equivalents than the non-Hispanic White group, except for the non-Hispanic multiracial (AOR=0.96; 95% CI=0.87, 1.07) and non-Hispanic American Indian/Alaska Native (AOR=1.06; 95% CI=0.96, 1.17) groups. Non-Hispanic Asian veterans had the lowest odds for any day of opioid overlap (AOR=0.54; 95% CI=0.50, 0.57) and daily dose >120 morphine milligram equivalents (AOR=0.43; 95% CI=0.36, 0.52). For any day of opioid-benzodiazepine overlap, all races/ethnicities had lower odds than non-Hispanic White. Non-Hispanic Black/African American (AOR=0.71; 95% CI=0.70, 0.72) and non-Hispanic Asian (AOR=0.73; 95% CI=0.68, 0.77) veterans had the lowest odds of any day of opioid-benzodiazepine overlap.

Conclusions: Non-Hispanic White and non-Hispanic American Indian/Alaska Native veterans had the greatest likelihood to receive an opioid prescription. When an opioid was prescribed, high-risk prescribing was more common in White and American Indian/Alaska Native veterans than in all other racial/ethnic groups. As the nation's largest integrated healthcare system, the Veterans Health Administration can develop and test interventions to achieve health equity for patients experiencing pain.

Published by Elsevier Inc.