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Citation
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Nguemeni Tiako MJ, Shofer F, Dolan A, Goldberg EB, Rhodes KV, Hess EP, Bellamkonda VR, Perrone J, Cannuscio CC, Becker L, Rodgers MA, Zyla MM, Bell JJ, McCollum S, Engel-Rebitzer E, Schapira MM, Meisel ZF. Acad. Emerg. Med. 2023; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: To determine the impact of personalized risk communication and opioid prescribing on nonprescribed opioid use, we conducted a secondary analysis of RCT participants followed prospectively for 90 days after an E.D. visit for acute back or kidney stone pain.
METHODS: One thousand three hundred-one individuals were randomized during an encounter at four academic EDs into a probabilistic risk tool arm, a narrative-enhanced probabilistic risk tool arm, or a general risk information arm (control). In this secondary analysis, both risk tool arms were combined and compared with the control arm. We used logistic regressions to determine associations between receiving personalized risk information, receiving an opioid prescription in the ED, and non-prescribed opioid use in general and by race.
RESULTS: Complete follow-up data were available for 851 participants, 23.3% (n=198) were prescribed opioids (34.2% of White, vs. 11.6% of Black participants, P<0.001). Fifty-six (6.6%) participants used non-prescribed opioids. Participants in the personalized risk communication arms had lower nonprescribed opioid use odds (aOR 0.58, 95% CI 0.4-0.83). Black vs White participants had greater non-prescribed opioid use odds (aOR 3.47, 95% CI 2.05-5.87, P<0.001). Black participants who were prescribed opioids had a lower marginal probability of using non-prescribed opioids vs those who weren't (0.06, 95% CI 0.04-0.08, P<0.001 vs. 0.10, 95% CI 0.08-0.11, P<0.001). The absolute risk difference in non-prescribed opioid use for Black and White participants, respectively, in the risk communication vs. the control arm, was 9.7% and 0.1% (relative risk ratio 0.43 vs. 0.95).
CONCLUSION: Among Black but not White participants, personalized opioid risk communication and opioid prescribing were associated with lower odds of nonprescribed opioid use. Our findings suggest that racial disparities in opioid prescribing - which have been previously described within the context of this trial -- may paradoxically increase non-prescribed opioid use. Personalized risk communication may effectively reduce nonprescribed opioid use, and future research should be designed specifically to explore this possibility in a larger cohort.
Language: en |