Journal CME, March 2022: Opioid Use and Social Disadvantage in Patients with Chronic Musculoskeletal Pain-Opioid Use and Social Disadvantage in Patients

Opioid Use and Social Disadvantage in Patients - Article.pdf

Pdf Summary

This study examines the relationship between opioid use and social disadvantage in patients with chronic musculoskeletal pain, particularly those treated at a single tertiary safety net medical center. Historically, marginalized patients received fewer opioid prescriptions compared to white, affluent patients. This study aims to determine if current opioid prescribing patterns have shifted, making socially disadvantaged patients more likely to be on chronic opioid therapy and experience worse health outcomes.<br /><br />The study utilized a cross-sectional analysis of medical records from 2000 to 2019, involving a cohort of 1,173 adult patients divided into two groups — 356 patients with chronic opioid use and 817 without. The main outcome measured was social disadvantage, assessed using the Area Deprivation Index (ADI), alongside the secondary outcomes of self-reported physical and behavioral health using PROMIS measures.<br /><br />Results indicated that patients on chronic opioid therapy were more likely to reside in the most socially disadvantaged communities (34.9% vs. 24.9%) and had worse behavioral health outcomes, including higher depression and anxiety scores. The likelihood of being managed with chronic opioids was higher for patients living in the most disadvantaged areas even after adjusting for age, sex, race, and PROMIS scores.<br /><br />The study suggests a potential reversal of previous disparities in opioid prescribing, attributed to a lack of access to nonopioid pain management options for socioeconomically disadvantaged populations, oftentimes due to inadequate health insurance. It highlights the necessity for improved access to multidisciplinary, nonopioid treatments to manage chronic pain and reduce the reliance on opioid prescriptions. The findings underscore the need for policy changes to offer better and more equitable healthcare solutions for treating chronic pain, particularly in underserved populations.

Keywords

opioid use

social disadvantage

chronic musculoskeletal pain

tertiary safety net medical center

Area Deprivation Index

chronic opioid therapy

behavioral health outcomes

nonopioid pain management

PROMIS measures

healthcare policy