Trends in Prescription Opioid and Nonopioid Analgesic Use by Race, 1996–2017

  • Gawon Cho
    Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York University, New York, New York
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  • Virginia W. Chang
    Address correspondence to: Virginia W. Chang, MD, PhD, Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York University, 708 Broadway, RM 633, New York NY 10003.
    Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York University, New York, New York

    Department of Population Health, NYU Grossman School of Medicine, New York University, New York, New York
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Published:December 06, 2021DOI:


      Identifying racial differences in trends in prescription opioid use (POU) is essential for formulating evidence-based responses to the opioid epidemic. This study analyzes trends in the prevalence of POU and exclusive nonopioid analgesic use (ENA) by race–ethnicity.


      The Medical Expenditure Panel Survey was used to examine analgesic use among civilian adults without cancer (age ≥18 years) between 1996 and 2017. The outcome classified individuals into 3 mutually exclusive categories of prescription analgesic use: no prescription analgesic, POU, and ENA. Analyses were conducted between December 2020 and April 2021.


      Among 250,596 adults, baseline analgesic usage varied with race–ethnicity, where non-Hispanic Whites had the highest POU (11.9%), and it was as prevalent as ENA (11.3%). Non-Hispanic Blacks and Hispanics had lower POU at baseline (9.3% and 9.6%, respectively), and ENA exceeded POU. Subsequently, POU increased across race–ethnicity with concomitant decreases in ENA, eventually eclipsing ENA in Whites and Blacks but not among Hispanics. Although POU among Blacks became as prevalent as it was among Whites in the 2000s–2010s, POU among Hispanics remained lower than the other groups throughout the 2000s–2010s. After the adoption of prescribing limits, POU declined across race–ethnicity by comparable levels in 2016–2017.


      Blacks and Hispanics were less likely to use opioids when they first became widely available for noncancer pain. Subsequently, POU displaced ENA among Whites and Blacks. Although POU is often associated with Whites, a significant proportion of the Black population may also be at risk. Finally, although lower POU among Hispanics may be protective of misuse, it could represent undertreatment.
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      1. Overdose death rates. NIH, National Institute on Drug Abuse. Updated January 29, 2021. Accessed April 3, 2021.

        • Nahin RL
        • Sayer B
        • Stussman BJ
        • Feinberg TM.
        Eighteen-year trends in the prevalence of, and health care use for, noncancer pain in the United States: data from the Medical Expenditure Panel Survey.
        J Pain. 2019; 20: 796-809
        • Jones MR
        • Viswanath O
        • Peck J
        • Kaye AD
        • Gill JS
        • Simopoulos TT.
        A brief history of the opioid epidemic and strategies for pain medicine.
        Pain Ther. 2018; 7: 13-21
        • Stokes A
        • Berry KM
        • Hempstead K
        • Lundberg DJ
        • Neogi T.
        Trends in prescription analgesic use among adults with musculoskeletal conditions in the United States, 1999-2016.
        JAMA Netw Open. 2019; 2e1917228
        • Green CR
        • KO Anderson
        • Baker TA
        • et al.
        The unequal burden of pain: confronting racial and ethnic disparities in pain [published correction appears in Pain Med. 2005;6(1):99].
        Pain Med. 2003; 4: 277-294
        • Hausmann LRM
        • Gao S
        • Lee ES
        • Kwoh KC.
        Racial disparities in the monitoring of patients on chronic opioid therapy.
        Pain. 2013; 154: 46-52
        • Gaither JR
        • Gordon K
        • Crystal S
        • et al.
        Racial disparities in discontinuation of long-term opioid therapy following illicit drug use among Black and White patients.
        Drug Alcohol Depend. 2018; 192: 371-376
        • Harrison JM
        • Lagisetty P
        • Sites BD
        • Guo C
        • Davis MA.
        Trends in prescription pain medication use by race/ethnicity among U.S. adults with noncancer pain, 2000–2015.
        Am J Public Health. 2018; 108: 788-790
        • Chowdhury SR
        • Machlin SR
        • Gwet KL.
        Sample designs of the Medical Expenditure Panel Survey household component, 1996–2006 and 2007–2016.
        Agency for Healthcare Research and Quality, Rockville MDJanuary 2019 (Methodology Report #33) (Accessed January 18, 2021)
      2. Agency for Healthcare Research and Quality. Accounting for clustering in the analysis of MEPS data: frequently asked questions (FAQ). Rockville MD: Agency for Healthcare Research and Quality. Accessed February 21, 2021.

        • Wang J
        • Zuckerman IH
        • Miller NA
        • Shaya FT
        • Noel JM
        • Mullins CD.
        Utilizing new prescription drugs: disparities among non-Hispanic Whites, non-Hispanic Blacks, and Hispanic Whites.
        Health Serv Res. 2007; 42: 1499-1519
        • Ailawadhi S
        • Parikh K
        • Abouzaid S
        • et al.
        Racial disparities in treatment patterns and outcomes among patients with multiple myeloma: a SEER-Medicare analysis.
        Blood Adv. 2019; 3: 2986-2994
        • Netherland J
        • Hansen HB.
        The war on drugs that wasn't: wasted whiteness, “dirty doctors,” and race in media coverage of prescription opioid misuse.
        Cult Med Psychiatry. 2016; 40: 664-686
        • Nicholson HL
        • Ford JA.
        Correlates of prescription opioid misuse among Black adults: findings from the 2015 National Survey on Drug Use and Health.
        Drug Alcohol Depend. 2018; 186: 264-267
        • Nicholson HL
        • Vincent J.
        Gender differences in prescription opioid misuse among U.S. Black adults.
        Subst Use Misuse. 2019; 54: 639-650
        • Sibila D
        • Pollock W
        • Menard S.
        Citizenship status and arrest patterns for violent and narcotic-related offenses in federal judicial districts along the U.S./Mexico border.
        Am J Crim Justice. 2017; 42: 469-488
        • Austin RL
        • Allen MD.
        Racial disparity in arrest rates as an explanation of racial disparity in commitment to Pennsylvania's prisons.
        J Res Crime Delinq. 2000; 37: 200-220
        • Lagisetty PA
        • Ross R
        • Bohnert A
        • Clay M
        • Maust DT.
        Buprenorphine treatment divide by race/ethnicity and payment.
        JAMA Psychiatry. 2019; 76: 979-981
        • Hadland SE
        • Bagley SM
        • Rodean J
        • et al.
        Receipt of timely addiction treatment and association of early medication treatment with retention in care among youths with opioid use disorder.
        JAMA Pediatr. 2018; 172: 1029-1037
        • Lippold KM
        • Jones CM
        • Olsen EO
        • Giroir BP.
        Racial/ethnic and age group differences in opioid and synthetic opioid-involved overdose deaths among adults aged ≥18 years in metropolitan areas - United States, 2015-2017.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 967-973
        • Dahlhamer J
        • Lucas J
        • Zelaya C
        • et al.
        Prevalence of chronic pain and high-impact chronic pain among adults - United States, 2016.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 1001-1006