Black and Hispanic patients with terminal cancer receive fewer opioids for pain, new study finds

The new study, published online today in the Journal of Clinical Oncology, is the most important to examine disparities in access to opioids among cancer patients in the country.

The researchers looked at opioid prescriptions between 2007 and 2019 for 318,549 Medicare terminal cancer patients over the age of 65 who were nearing the end of their life.

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

When black and Hispanic patients received opioids for pain management, they generally received lower doses in the last month of life than the average white patient, according to the results. According to Dr. Alexi Wright, medical oncologist and director of gynecologic oncology outcomes research at the Dana-Farber Cancer Institute and lead author of the study.

“Cancer pain is one of the few conditions for which there is broad consensus that opioids are the treatment of choice,” said Dr. Astha Singhal, assistant professor at the Henry M. Goldman School of Dental Medicine. from Boston University, which was not involved in the research. . “Pain management is one of the main goals of cancer patients at the end of life, so to see the disparities in this group is quite striking”

The study found a steady decline in access to opioids for patients of all races and a rapid increase in urine drug testing over this period. Black patients, however, were more likely than any other group undergo urine drug screening when receiving opioid treatment.

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

Increased restrictions on prescription opioids following a national opioid crisis have dramatically reduced patient access to these medications. Although the restrictions are intended to curb the abuse of opioids, the researchers noted that in some cases they have made it harder for terminal cancer patients to get the painkillers they need.

Since the Centers for Disease Control and Prevention released its opioid guidelines in 2016, more than half of US states have adopted legislation restricting the prescription of opioids and/or an acute pain waiver citing the 2016 CDC guidelines. Although these guidelines excluded patients with active cancer, they have been widely “misenforced…resulting in significant opioid access issues for people with chronic pain, including cancer,” according to Dr. Salimah Meghani, professor of nursing at the University of Pennsylvania. School of Nursing which studied racial disparities in pain treatment.

“Obviously a lot of these regulations are appropriate because we want to stem the tide of the opioid crisis, but they’ve been a very brutal tool,” Enzinger said. “It’s not just cancer patients, we’re looking at dying cancer patients.”

The results of the new study suggest doctors lack “confidence” that their black and Hispanic patients won’t abuse the drug, Warraich said. He said this was particularly inappropriate given that over the course of the study, overdose deaths and opiate addiction rates were statistically much higher among whites.

Previous studies have found that doctors who under-prescribe painkillers to blacks have false beliefs about biological differences between races. A 2016 investigation of 222 white medical students and residents found that half believed black people felt less pain than white people, a myth that dates back to the days of slavery.

The authors of the new study plan to continue their research into racial disparities in cancer patients’ pain management to identify the main causes of these inequities and design appropriate solutions.

“Our next step is to understand the drivers of this and see to what extent this may be explained by the behaviors of individual physicians, clinics instituting drug testing policies or regional level elements such as access to pharmacies,” Wright said. “To understand it, but above all, to change it.”

Zeina Mohammed can be contacted at [email protected]. Follow her on Twitter @_ZeinaMohammed.