Trends and racial/ethnic differences in opioid prescribing safety and use of nonpharmacologic treatments for chronic pain in adults with co-occurring opioid use disorder

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In the climate of increased opioid-related morbidity and mortality in the U.S., the safe, effective and comprehensive management of chronic pain is critically important. People with comorbid chronic pain and OUD and racial and ethnic minorities deserve specific attention due to their potential under-treatment of pain and OUD, and elevated risk of adverse health outcomes. In 2016, the Centers for Disease Control and Prevention (CDC) released a prominent clinical practice guideline that emphasizes non-opioid and non-drug alternatives for pain management, and recommends safer prescribing practices if opioids are prescribed to treat chronic pain. An examination of chronic pain treatment patterns over time and in vulnerable subgroups of minorities and people with co-occurring OUD is needed to understand and address health disparities in the delivery of guideline concordant treatment for chronic pain. Using 2015 to 2018 Medicare enrollment data combined with inpatient, outpatient and prescription claims data from a 20% national sample, the proposed research aims to: (1) assess racial and ethnic disparities in the types of chronic pain treatments provided to people with comorbid OUD, and (2) evaluate whether the implementation of the CDC guideline influenced racial/ethnic disparities in the treatment of chronic pain for those with OUD. We will categorize pain treatments as pharmacologic, non-pharmacologic, and combination of pharmacologic and non-pharmacologic. Among those prescribed opioids, we will assess the guideline concordance of prescribing as it relates to opioid dosage and concurrent benzodiazepine prescriptions. We hypothesize that racial/ethnic minorities with OUD are less likely to receive guideline concordant opioid management and non-drug therapy than White chronic pain patients with OUD. We further anticipate worsened disparities in chronic pain treatment following release of the CDC opioid guideline. If confirmed, we will explore potential sources of disparities (e.g., co-prescribing of naloxone, involvement of pain and addiction specialists) that could inform interventions to improve chronic pain treatment in those with cooccurring OUD. The long-term goal of this research is to characterize and reduce disparities in receipt of recommended standards of care and evidence-based treatment for people with co-occurring chronic pain and OUD. Our findings will provide much needed evidence for more effective and equitable public health and health insurance policy, and can inform future clinical guidelines.