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

  • Gawon Cho
    Affiliations
    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
    Correspondence
    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.
    Affiliations
    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:https://doi.org/10.1016/j.amepre.2021.08.016

      Introduction

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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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