OBJECTIVES:

Racial disparities in opioid prescribing for pain have been reported for the past two decades. While the disparity has decreased over time, there remains a gap in low back pain (LBP). For example, past studies have shown that black patients are less likely to receive an opioid prescription relative to white patients for LBP. This study seeks to explore whether differences in opioid prescribing exist not just by patient race, but also by prescriber race.

METHODS:

We used a de-identified, longitudinal, open medical and prescription claims database in the U.S. linked to patient and prescriber race to evaluate rates of opioid prescription for new episodes of LBP. Rates were stratified by patient and prescriber race and adjusted using multivariate regression controlling for age, gender, insurance, co-morbidities, and prescriber characteristics.

RESULTS:

The final cohort included 7.3 M new episodes of low back pain across 5.9 M unique patients from 2017 to 2019. In unadjusted analysis, white physicians prescribed opioids more often to white patients relative to black patients (1.93% vs 1.77%, p < .001). In adjusted analysis, white physicians were less likely to prescribe opioids to black patients relative to white patients (OR 0.86 - 0.90 95% CI, p < .001). Black patients were more likely to be prescribed opioids by black physicians relative to white physicians (OR 1.07 - 1.14 95% CI, p < .001).

CONCLUSIONS:

The study provides further evidence of racial disparities in opioid prescribing for LBP by patient race, and suggests that prescriber race may play a role in the disparity. Future work should explore these results in additional databases containing both patient and prescriber race.