• Mechelle Sanders, Kevin Fiscella, Mathew Devine, Jefferson Hunter, Yasin Mohamed, and Colleen T Fogarty.
• From the University of Rochester, Department of Family Medicine Family Medicine Research Rochester, NY (MS, KF, CF); Rochester Regional Health, Unity Faculty Partners, Rochester, NY (MD); University of Rochester Medical Center, Rochester, NY (JH, YM). Mechelle_sanders@urmc.rochester.edu).
• J Am Board Fam Med. 2024 Aug 14; 37 (3): 383388383-388.

BackgroundThe 2022 Centers for Disease Control's "Clinical Practice Guidelines for Prescribing Opioids for Pain in United States" called for attention and action toward reducing disparities in untreated and undertreated pain among Black and Latino patients. There is growing evidence for controlled substance safety committees (CSSC) to change prescribing culture, but few have been examined through the lens of health equity. We examined the impact of a primary care CSSC on opioid prescribing, including by patients' race and sex.MethodsWe conducted a retrospective cohort study. Our primary outcome was a change in prescribed morphine milligram equivalents (MME) at baseline (2017) and follow-up (2021). We compared the differences in MME by race and sex. We also examined potential intersectional disparities. We used paired t test to compare changes in mean MME's and logistic regression to determine associations between patient characteristics and MME changes.ResultsOur cohort included 93 patients. The mean opioid dose decreased from nearly 200 MME to 136.1 MME, P < .0001. Thirty percent of patients had their dose reduced to under 90 MME by follow-up. The reduction rates by race or sex alone were not statistically significant. There was evidence of intersectional disparities at baseline. Black women were prescribed 88.5 fewer MME's at baseline compared with their White men counterparts, P = .04.DiscussionOur findings add to the previously documented success of CSSCs in reducing opioid doses for chronic nonmalignant pain to safer levels. We highlight an opportunity for primary care based CSSCs to lead the efforts to identify and address chronic pain management inequities.© Copyright 2024 by the American Board of Family Medicine.

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