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Disparities in Opioid Prescribing in Traumatically Injured Patients
Cara Michael
1, Sophia M. Smith
2, Rachel Adams
2, Emily J. Ha
1, Kendall Jenkins
1, Wang Pong Chan
1, Noelle N. Saillant
2, Jeffrey Franks
2, Sabrina Sanchez
2
1Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 2Boston Medical Center, Boston, MA.
Background: Disparities in opioid prescribing are well-documented, albeit not in the trauma population. We sought to evaluate opioid administration trends after traumatic injury and their association with patient characteristics.
Methods: We conducted a retrospective review of trauma admissions, 1/1/2018-12/31/2021, examining demographic, injury, and hospitalization data. Opioids were quantified in morphine milligram equivalents (MMEs). Pain control days prescribed at discharge were calculated based on MMEs administered 24 hours prior to discharge. Adjusted analyses included multivariable logistic regression for opioid receipt, general linear modeling for mean daily MMEs, and negative binomial regression for pain control days prescribed at discharge.
Results: Of 3,032 patients, 1,803 (72%) required opioids 24 hours prior to discharge; 1,310 (73%) of these were discharged with opioids. Higher hospitalization MMEs were associated with homelessness (?=47.79, p=0.003), depression/anxiety (?=14.36, p=0.05), and substance use disorder (SUD) (?=41.27, p<0.001). Black and Hispanic patients received lower hospitalization MMEs (?=-24.94, p<0.001, -21.96, p=0.01). Among patients requiring opioids at discharge, those with SUD (OR=0.69, 95% CI=0.49-0.97, p=0.03) and violently injured (OR=0.61, 95% CI=0.45-0.85, p=0.003) had lower odds of discharge opioid prescriptions. Additionally, non-white patients were prescribed lower MMEs at discharge (median=75.00 MMEs vs 100.00 MMEs, IQR=50.00-150.00, p<0.001).
Conclusion: Significant disparities exist in opioid prescribing in trauma patients, with racial disparities in dosing and lower odds of discharge opioid prescriptions in patients with SUD despite higher inpatient needs. This highlights the need for evaluation of inpatient opioid prescribing patterns and the development of standardized discharge pain management practices that mitigate provider bias.
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