Originally published by our sister publication Anesthesiology News

Substantial and persistent racial and ethnic disparities not mediated by socioeconomic variables are present in access to opioid treatment among older patients dying of cancer, according to a new study.

To characterize racial and ethnic inequalities and trends in opioid access and urine drug screening, researchers used the Centers for Medicare & Medicaid Services administrative data for a 20% random sample of beneficiaries (J Clin Oncol 2023;JCO2201413. doi:10.1200/JCO.22.01413). Between Jan. 1, 2007, and Dec. 31, 2019, they identified 318,549 white, Black and Hispanic Medicare decedents over the age of 65 years with poor-prognosis cancers, nearing the end of their lives.

The researchers then examined trends in opioid prescription fills and potency (morphine milligram equivalents [MMEs] per day [MMEDs]) near the end of life, which was 30 days prior to death or hospice enrollment.

By multiplying the total dose of each opioid prescription filled near the end of life by standard conversion factors, summing all prescriptions and averaging over 30 days, the researchers were able to determine decedents’ mean daily opioid dose in MMEs per MMEDs.

The findings showed that between 2007 and 2019, all identified patients experienced a steady decline in access to opioids and a rapid surge in urine drug screening.

The researchers reported that Black patients were 4.3% less likely to receive any opioid compared with white patients. White patients near the end of their lives were 3% more likely to receive a long-lasting opioid compared with Black patients.

The researchers added that these differences are statistically significant because by 2019, only 32.7% of patients received any opioid and approximately 9% were treated with a long-acting opioid near the end of life. They also noted that these differences in access were most stark for Black men. When examining end-of-life opioid access by race, ethnicity and sex, the data showed that white men were most likely to have access to opioids, while Black men were least likely to receive opioids.

“We found that Black men were far less likely to be prescribed reasonable doses than white men were,” said researcher Alexi Wright, MD, MPH, a gynecologic oncologist and a researcher in Dana-Farber Cancer Institute’s Division of Population Sciences, in Boston. “Black men were less likely to receive long-acting opioids, which are essential for many patients dying of cancer. Our findings are startling because everyone should agree that cancer patients should have equal access to pain relief at the end of life.”

Compared with white women, white men near the end of life filled a mean total opioid dose that was 150 MMEs more per decedent (95% CI, 130-169 MMEs) and Black women filled 128 MMEs less than white women (95% CI, 168 to 153 MMEs). Black men filled 153 MMEs less than those filled by white women (95% CI, –195 to –110 MMEs). The researchers reported that Black men were also disproportionally affected by racial disparities in urine drug screening.

“Screening needs to either be applied uniformly or not at all for patients in this situation,” Wright said.

By Landon Gray

Enzinger reported no relevant financial disclosures.