Race and Gender Disparities in Physician Judgements of Opioid-related Risk in Patients with Chronic Pain

Abstract

Opioid-related risk assessment is a key component of safe and effective pain care. Prior opioid misuse is a known predictor of opioid-related risk, but its predictive quality depends on the specific behavior – some behaviors confer high risk (red flag), whereas others confer medium (yellow flag) or low risk (green flag). Race and gender disparities in opioid prescribing are well documented, but little is known about how patient race and gender interact with prior opioid misuse to impact physicians’ risk assessments. One hundred physicians were presented 12 virtual patients (videos and text vignettes) with chronic pain who varied by race (Black, White), gender (female, male), and prior opioid nonadherence (red, yellow, green flag). Physicians made assessment decisions about patients’ risk for future opioid-related adverse events, abuse/misuse, diversion, and opioid use disorder (OUD). Linear mixed effects models examined the independent and interactive effects of patient race, gender, and prior opioid misuse on physicians’ risk assessments. Results indicated that severity of prior opioid nonadherence significantly impacted physicians’ risk assessments for future opioid-related adverse events, prescription misuse/abuse, diversion, and OUD. However, these effects differed based on patient gender. Men with yellow flag behaviors were rated at higher risk for adverse events, abuse/misuse, and OUD relative to women with yellow flag behaviors. Conversely, among patients with red flag behaviors, women were rated at higher risk for adverse events, abuse/misuse, and OUD relative to men. Patient race did not impact physicians’ risk assessments. These findings inform efforts to enhance equity and outcomes in chronic pain care.