Did prescribing laws disproportionately affect opioid dispensing to Black patients?

Objective: To evaluate whether pain management clinic laws and prescription drug monitoring program (PDMP) prescriber check mandates, two state opioid policies with relatively rapid adoption across states, reduced opioid dispensing more or less in Black versus White patients. Data Sources: Pharmacy claims data, US sample of commercially insured adults, 2007-2018. Study Design: Stratifying by race, we used generalized estimating equations with an event-study specification to estimate time-varying effects of each policy on opioid dispensing, comparing to the four pre-policy quarters and states without the policy. Outcomes included high-dosage opioids, overlapping opioid prescriptions, concurrent opioid/benzodiazepines, opioids from >3 prescribers, opioids from >3 pharmacies. Data Extraction Methods: We identified all prescription opioid dispensing to Black and White adults aged 18-64 without a palliative care or cancer diagnosis code. Principal Findings: Exactly 7,096,592 White and 1,167,310 Black individuals met inclusion criteria. Pain management clinic laws were associated with reductions in two outcomes; their association with high-dosage receipt was larger among White patients. In contrast, reductions due to PDMP mandates appeared limited to, or larger in, Black patients compared with White patients in four of five outcomes. For example, PDMP mandates reduced high-dosage receipt in Black patients by 0.7 percentage points (95% CI: 0.36-1.08 ppt.) over 4 years: an 8.4% decrease from baseline; there was no apparent effect in White patients. Similarly, while there was limited evidence that mandates reduced overlapping opioid receipt in White patients, they appeared to reduce overlapping opioid receipt in Black patients by 1.3 ppt. (95% CI: -1.66--1.01 ppt.) across post-policy years-a 14.4% decrease from baseline. Conclusions: PDMP prescriber check mandates but not pain management clinic laws appeared to reduce opioid dispensing more in Black patients than White patients. Future research should discern the mechanisms underlying these disparities and their consequences for pain management. KEYWORDS opioids, policy, prescriptions, racial discrimination, racial disparities, racial inequity What is known on this topic * Pain management clinic laws and prescription drug monitoring program prescriber check mandates ('PDMP mandates') can reduce prescription opioid dispensing. * Throughout the ongoing drug overdose crisis, Black Americans have experienced lower rates of overdose attributable to medical and nonmedical use of prescription opioids. * On average, Black patients receive fewer opioids for a given diagnosis than White patients and are more likely to experience dose reductions and opioid discontinuation, and this difference is not explained by relevant clinical factors. What this study adds * PDMP mandates appeared to reduce opioid dispensing more in Black patients than in White patients, despite lower rates of dispensing at baseline. * Pain management clinic laws appeared to reduce some opioid dispensing outcomes; in one case, the estimated effect was larger in White compared with Black patients.
1 | INTRODUCTION Opioid prescribing, which accelerated dramatically in the mid-1990s, contributed to the first wave of the modern opioid overdose crisis. (1) This prompted a large policy response to [...]