Both Race and Insurance Type Independently Predict the Selection of Oral Opioids Prescribed to Cancer Outpatients

Abstract

Previous research suggests that racial disparities in the report of analgesic adverse effects are partially mediated by the type of opioid prescribed to African Americans despite the presence of certain comorbidities, such as renal disease. We aimed to identify independent predictors of the type of opioid prescribed to cancer outpatients and determine if race and chronic kidney disease (CKD) independently predict prescription type, adjusting for relevant sociodemographic and clinical confounders. We conducted secondary analysis of a 3-month observational study. Cancer patients (N=241) were from outpatient oncology clinics within a large mid-Atlantic healthcare system. Patients were older than 18 years of age, self-identified as African Americans or Whites, and had an analgesic prescription for cancer pain. Consistent with published literature, most patients (75.5%) were prescribed either morphine or oxycodone preparations as oral opioid therapy for cancer pain. When compared to Whites, African Americans were significantly more likely to be prescribed morphine (14% vs. 33%) and less likely to be prescribed oxycodone (64% vs. 38%, respectively, p<0.001). The estimated odds for African Americans to receive morphine were 2.573 times that for Whites (95% CI = 1.077 and 6.145) after controlling for insurance type, income, and pain levels. In addition, presence of private health insurance was negatively associated with the prescription of morphine and positively associated with prescription of oxycodone in separate multivariable models. Presence of CKD did not predict type of analgesic prescribed. Both race and insurance type independently predict type of opioid selection for cancer outpatients. Future larger clinical studies are needed to fully understand the sources and clinical consequences of racial differences in opioid selection for cancer pain.