Black and Hispanic patients with terminal cancer take lower opioid doses for pain, new study finds

new research, Published online today The Journal of Clinical Oncology is the largest agency to examine disparities in opioid access among cancer patients in the country.

Between 2007 and 2019, researchers examined opioid prescriptions for 318,549 Medicare patients with terminal cancer who were 65 years or older and nearing the end of life.

They found that compared with white patients, black patients were 4.3% less likely to receive opioids at the end of life and 3.2% less likely to receive long-acting opioids. Hispanic patients were 3.6% less likely to receive opioids and 2.2% less likely to receive long-acting opioids.

Findings show that when black and Hispanic patients were given opioids for pain management, they typically received lower doses during the first month of life than the average white patient. Black men face the greatest inequality and are least likely to be prescribed a “reasonable dose,” according to Alexi Wright, M.D., director of Gynecologic Oncology Outcomes Research at Farber Cancer Institute. Turned out to be demographics. of research.

“Cancer pain is one of the few conditions for which there is broad consensus that opioids are the treatment of choice,” said Astha Singhal, M.D., assistant professor of medicine at Boston University’s Henry M. Goldman School of Dentistry. However, he was not involved in this study. “Pain management is one of the major goals of terminally ill cancer patients, so it is very striking to see the disparities in this group.”

The study found a steady decline in access to opioids in patients of all races and a rapid increase in urine drug screening during that period. was more likely than Having a urine drug test while on opioid therapy.

“These patients are nearing the end of life,” said Dr. Andrea Enzinger, a medical oncologist and palliative care physician at the Dana-Farber Cancer Institute and lead author of the study. “Unless they have a known history of substance abuse or other very strong indications, it’s hard to imagine why this would be such an important part of their pain treatment.

Increased restrictions on prescription opioids in the wake of the national opioid crisis have significantly reduced patient access to these drugs. The restrictions are aimed at curbing opioid abuse, but researchers note that in some cases, it makes it more difficult for terminally ill cancer patients to get the pain relievers they need.

Since the Centers for Disease Control and Prevention released opioid guidelines in 2016, more than half of the states in the United States have adopted opioid guidelines. Laws Restricting Prescribing Opioids and/or Acute Pain Dispensing Citing 2016 CDC Guidelines. These guidelines, which excluded patients with active cancer, are widely “misapplied and suffer from chronic pain, including cancer,” said Dr. Salima Megani, a professor of nursing at the University of Pennsylvania. It poses a significant opioid access problem for humans.” School of Nursing that studied race-based disparities in pain treatment.

“Obviously, many of these regulations are appropriate because we want to stem the tide of the opioid crisis, but they were very blunt measures,” said Enzinger. “These are not just cancer patients. We are seeing cancer patients dying.”

The results of the new study suggest doctors lack “trust” that their black and Hispanic patients will not misuse the drug, Waraich said. He said this was particularly inappropriate given that whites had statistically much higher death and poisoning rates from drug overdose.

Previous research found that physicians who underprescribe painkillers to black people have false beliefs about biological differences between races. 2016 Research Of 222 white medical students and residents, half believed that blacks felt less pain than whites. This is a myth that dates back to the days of slavery.

The authors of the new study plan to continue investigating racial disparities in pain management for cancer patients to identify the main causes of these inequities and devise appropriate solutions.

“Our next step is to understand this factor and how much this can be explained by individual physician behavior, clinics enacting drug screening policies, or local level issues such as access to pharmacies.” It’s about making sure you’re doing it,” says Wright. “Understanding it, but the important thing is to change it.”

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