Racial disparities in discontinuation of long-term opioid therapy following illicit drug use among black and white patients

•Urine drug testing is recommended for all patients receiving opioid therapy.•Whites are at higher risk of opioid overdose.•Yet blacks are more likely to receive urine drug testing (UDT).•Blacks are more likely to have opioids discontinued following a positive UDT.•A more universal approach to urine...

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Bibliographic Details
Published in:Drug and alcohol dependence 2018-11, Vol.192, p.371-376
Main Authors: Gaither, Julie R., Gordon, Kirsha, Crystal, Stephen, Edelman, E. Jennifer, Kerns, Robert D., Justice, Amy C., Fiellin, David A., Becker, William C.
Format: Article
Language:English
Subjects:
Adult
African Continental Ancestry Group - ethnology
African Continental Ancestry Group - psychology
Aged
Analgesics, Opioid - administration & dosage
Cannabis
Chronic pain
Chronic Pain - drug therapy
Chronic Pain - ethnology
Chronic Pain - psychology
Cocaine
Computerized medical records
Confidence intervals
Discontinued
Drug abuse
Drug testing
Drug use
Electronic health records
Electronic Health Records - trends
Electronic medical records
European Continental Ancestry Group - ethnology
European Continental Ancestry Group - psychology
Female
Healthcare Disparities - ethnology
Healthcare Disparities - trends
Humans
Illicit Drugs - adverse effects
Illicit Drugs - urine
Male
Marijuana
Medical records
Middle Aged
Narcotics
Opioid analgesics
Opioids
Outpatients
Pain
Patients
Practice guideline
Quality of health care
Race
Racial differences
Racial disparities
Racial inequality
Regression analysis
Statistical analysis
Substance Abuse Detection - trends
Substance abuse treatment
Substance-Related Disorders - ethnology
Substance-Related Disorders - psychology
Substance-Related Disorders - therapy
Therapy
Time Factors
Urine
Urine drug testing
Urine tests
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Summary:•Urine drug testing is recommended for all patients receiving opioid therapy.•Whites are at higher risk of opioid overdose.•Yet blacks are more likely to receive urine drug testing (UDT).•Blacks are more likely to have opioids discontinued following a positive UDT.•A more universal approach to urine drug testing is needed. Among patients prescribed long-term opioid therapy (LTOT) for chronic pain, no study has yet examined how clinicians respond to evidence of illicit drug use and whether the decision to discontinue opioids is influenced by a patient’s race. Among outpatients of black and white race initiating LTOT through the VA between 2000 and 2010, we reviewed electronic medical records to determine whether opioids were discontinued within 60 days of a positive urine drug test. Logistic regression was used to examine differences by race. Among 15,366 patients of black (48.1%) or white (51.9%) race initiating LTOT from 2000 to 2010, 20.5% (25.5% of blacks vs. 15.8% of whites, P
ISSN:0376-8716
1879-0046
DOI:10.1016/j.drugalcdep.2018.05.033