Expert Details ‘Pervasive’ Racial/Ethnic Opioid Access Disparities in Cancer

There were “meaningful” differences in opioid access for cancer near the end of life between Black, White, and Hispanic patients, according to Andrea C. Enzinger, MD.

CancerNetwork^® spoke with Enzinger, assistant professor of medicine at Harvard Medical School and medical oncologist at Dana-Farber Cancer Institute, about data from a study investigating these disparities.

She indicated that Black patients were 4.3% less likely to receive any opioid and 3.1% less likely long-acting opioids than their White counterparts. Similar patterns were observed when Hispanic patients were compared with White patients, Enzinger said. Additionally, Black and Hispanic patients received lower average total doses of opioids compared with White patients.

Transcript:

We found really striking and pervasive inequities in access to prescription opioids among older, Medicare-insured patients who were dying from cancer. We looked at over 300,000 Black, White, and Hispanic patients who had a poor prognosis cancer and died between 2007 and 2019. What we saw was across a host of different measures.

If you looked at, for example, the proportion of patients who filled 1 or more opioid prescriptions in the last month of life, Black patients were about 4.3% less likely to fill any opioid prescription than White patients and Hispanic patients had a similar difference. That may sound like a small number but you have to keep in mind that by 2019, only a little over 30% of any patient filled a prescription opioid. If you’re looking at a 4.3% difference between Black and White patients with an overall cohort prevalence of about 30%, that’s a really meaningful difference.

We saw larger differences in access for long-acting opioids, which are really critical for palliating severe and persistent pain from advanced cancers. Black patients were about 3.2% less likely than White patients to fill a long-acting opioid prescription in the last month of life. And the differences are pretty similar between Hispanic and White patients. To put that in context, by 2019, only about 9% of dying patients [with cancer] filled a long-acting opioid in the last month of life; a difference of 3 or more percentage points is really huge.

We also found that when patients of color actually filled a prescription, the doses were lower. A really useful metric is to look at the difference in average total dose filled by patients of color vs White patients. As an example, Black patients received or filled about 200 morphine milligram equivalents less in the last month of life than White patients; that comes out to somewhere around 28 tablets of 5 mg oxycodone tablets in the last month of life. [That is] about 1 less pill per day for the average Black patient as compared to the average White patient. Again, we saw similar differences between Hispanic and White populations.

Reference

Enzinger AC, Ghosh K, Keating NL, et al. Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life. J Clin Oncol. Published online January 10, 2023. doi:10.1200/JCO.22.01413