• Utibe R Essien, Florentina E Sileanu, Xinhua Zhao, Jane M Liebschutz, Carolyn T Thorpe, Chester B Good, Maria K Mor, Thomas R Radomski, HausmannLeslie R MLRMCenter for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Michael J Fine, and Walid F Gellad.
• Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. utibe.essien@va.gov.
• J Gen Intern Med. 2020 May 1; 35 (5): 153715441537-1544.

BackgroundAfter non-fatal opioid overdoses, opioid prescribing patterns are often unchanged and the use of medications for opioid use disorder (MOUDs) remains low. Whether such prescribing differs by race/ethnicity remains unknown.ObjectiveTo assess the association of race/ethnicity with the prescribing of opioids and MOUDs after a non-fatal opioid overdose.DesignRetrospective cohort study.ParticipantsPatients prescribed ≥ 1 opioid from July 1, 2010, to September 30, 2015, with a non-fatal opioid overdose in the Veterans Health Administration (VA).Main MeasuresPrimary outcomes were the proportion of patients prescribed: (1) any opioid during the 30 days before and after overdose and (2) MOUDs within 30 days after overdose by race and ethnicity. We conducted difference-in-difference analyses using multivariable regression to assess whether the change in opioid prescribing from before to after overdose differed by race/ethnicity. We also used multivariable regression to test whether MOUD prescribing after overdose differed by race/ethnicity.Key ResultsAmong 16,210 patients with a non-fatal opioid overdose (81.2% were white, 14.3% black, and 4.5% Hispanic), 10,745 (66.3%) patients received an opioid prescription (67.1% white, 61.7% black, and 65.9% Hispanic; p < 0.01) before overdose. After overdose, the frequency of receiving opioids was reduced by 18.3, 16.4, and 20.6 percentage points in whites, blacks, and Hispanics, respectively, with no significant difference-in-difference in opioid prescribing by race/ethnicity (p = 0.23). After overdose, 526 (3.2%) patients received MOUDs (2.9% white, 4.6% black, and 5.5% Hispanic; p < 0.01). Blacks (adjusted OR (aOR) 1.6; 95% CI 1.2, 1.9) and Hispanics (aOR 1.8; 95% CI 1.2, 2.6) had significantly larger odds of receiving MOUDs than white patients.ConclusionsIn a national cohort of patients with non-fatal opioid overdose in VA, there were no racial/ethnic differences in changes in opioid prescribing after overdose. Although blacks and Hispanics were more likely than white patients to receive MOUDs in the 30 days after overdose, less than 4% of all groups received such therapy.

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