The wide-reaching concerns posed by opioids to patient safety and claim outcomes are well understood within workers’ compensation, and we have implemented many effective measures as an industry to tackle the opioid challenge. These efforts have been further bolstered by broad federal and state-based legislation that has occurred over the past several years, contributing to positive outcomes on a national level, including reduced prescribing rates and lower average morphine equivalent dose (MED).1
However, like most challenges facing our industry, there are nuances to consider that can lend further insight into our continued assessment of opioid utilization and risk among injured worker populations.
Diverse factors within populations such as patient race/ethnicity, socioeconomic status, geographic location, age and gender, mental health status, and even occupation bring forth differentiated findings as they relate to opioid prescribing behaviors and patient outcomes. Simply put, while opioids pose a risk in some form or fashion to all patients – this does not necessarily occur on an “equal opportunity” basis.
Diversity Factor: Race/Ethnicity
The relationship between race/ethnicity and opioids is complex and evolving. Historically, trends have shown racial disparities in pain management, and specifically in the opioid prescribing behaviors of doctors. Until recently, non-Hispanic white patients were more likely to be prescribed opioids and faced higher risk for prescription opioid overdose. However, a national trends study published in June indicates that the gap has closed between whites and blacks in regard to opioid prescribing for noncancer pain.2
While eliminating treatment disparity represents positive movement from a public health equality perspective, increased prescribing of opioids among black patients has created some negative consequences that include increased rates of opioid misuse within this population. While self-reported prescription opioid misuse remains highest among the white population at 4.5% nationally, other race/ethnic groups including Hispanic (4.2%), native Hawaiian or Pacific Islander (4.2%), and black (3.9%) populations are now proportionally very close from a risk perspective. However, non-Hispanic white individuals are still twice as likely to die from prescription opioid overdose compared with non-Hispanic black individuals.1
In addition to these shifting dynamics, interrelationships between race/ethnicity, socioeconomic status and geographic location add to the complexity when analyzing population-based risks.