Patient race and opioid misuse history influence provider risk perceptions for future opioid-related problems

Abstract

In response to the dual public health crises of chronic pain and opioid use, providers have become more vigilant about assessing patients for risk of opioid-related problems. Little is known about how providers are making these risk assessments. Given previous studies indicating that Black patients are at increased risk for suboptimal pain care, which may be related to stereotypes about drug abuse, the current study examined how patient race and previous opioid misuse behaviors impact providers' risk assessments for future prescription opioid-related problems. Physician residents and fellows (N = 135) viewed videos and read vignettes about 8 virtual patients with chronic pain who varied by race (Black/White) and history of prescription opioid misuse (absent/present). Providers rated patients' risk for future prescription opioid-related adverse events, misuse/abuse, addiction, and diversion, and also completed measures of implicit racial attitudes and explicit beliefs about race differences in pain. Two significant interactions emerged indicating that Black patients were perceived to be at greater risk for future adverse events (when previous misuse was absent) and diversion (when previous misuse was present). Significant main effects indicated that Black patients and patients with previous misuse were perceived to be at greater risk for future misuse/abuse of prescription opioids, and that patients with previous misuse were perceived to be at greater risk of addiction. These findings suggest that racial minorities and patients with a history of prescription opioid misuse are particularly vulnerable to any unintended consequences of efforts to stem the dual public health crises of chronic pain and opioid use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Figure 1. Risk Perception of an Adverse Opioid-related Event

Note: Estimated marginal means and 95% CI bars are displayed. Perceived risk ratings range from 0 to 4 with higher numbers representing greater risk.

Figure 2. Risk Perception of Prescription Opioid Misuse/abuse

Note: Estimated marginal means and 95% CI bars are displayed. Perceived risk ratings range from 0 to 4 with higher numbers representing greater risk.

Figure 3. Concern about Opioid Diversion

Note: Estimated marginal means and 95% CI bars are displayed. Perceived risk ratings range from 0 to 4 with higher numbers representing greater risk.

Figure 4. Concern about Addiction

Note: Estimated marginal means and 95% CI bars are displayed. Perceived risk ratings range from 0 to 4 with higher numbers representing greater risk.