Race and ethnicity: Not factors in the prescribing of hydrocodone- and codeine-containing products in two pediatric emergency departments

Authors

  • Chris A. Rees, MD, MPH
  • Melanie Brooke Bernhardt, PharmD
  • Elizabeth A. Camp, PhD
  • Jessica S. Lin, BA
  • Corrie E. Chumpitazi, MD, MS

DOI:

https://doi.org/10.5055/jom.2019.0506

Keywords:

opioids, DEA rescheduling, pediatric, emergency department, race, ethnicity

Abstract

Objective: To describe the prescription of hydrocodone-containing products (HCPs) and codeine-containing products (CCPs) by patient and provider race and ethnicity at two pediatric emergency departments (EDs) before and after the US Drug Enforcement Administration (DEA) rescheduling of HCPs in 2014.

Design and setting: The authors performed a secondary analysis of data describing the prescription of HCPs and CCPs for 6 months before and after the DEA rescheduling of HCPs in two academic, urban pediatric EDs.

Patients, participants: The authors included all children for whom race and ethnicity data were available and who were prescribed HCPs or CCPs at the time of discharge from the ED during a 12-month period (n = 1,246). The authors sent a three-question survey soliciting name, race, and ethnicity to all providers who prescribed an HCP or a CCP during the study period.

Main outcome measures: Chi-square comparisons were made between the number of HCP and CCP prescriptions for primary ED diagnosis and patient ethnicity or race. The number of HCP and CCP prescriptions before and after the DEA rescheduling were compared to patient and provider race and ethnicity using the Breslow-Day test for homogeneity.

Results: There were no significant differences in the number of HCP and CCP prescriptions between the pre- and post-DEA rescheduling periods across all racial and ethnic groups. When comparing the number of HCP and CCP prescriptions to patient race, Caucasian patients (84.4 percent) were prescribed more HCPs and CCPs than African Americans (15.6 percent) for abdominal pain (p value = 0.02). Non-Hispanic providers prescribed CCPs more often (n = 38, 55.2 percent) than Hispanic providers (n = 0, 0.0 percent) after DEA rescheduling (Breslow-Day p value = 0.01). Providers of all races wrote similar numbers of HCP and CCP prescriptions before and after the DEA rescheduling (Breslow-Day p value = 0.99).

Conclusions: Pediatric patients of all races and ethnicities received fewer HCP prescriptions after the 2014 DEA rescheduling of HCPs. However, Caucasian patients were prescribed HCPs and CCPs for abdominal pain more frequently than African American patients. There were no significant differences in the number of prescriptions of HCPs and CCPs by provider race.

Author Biographies

Chris A. Rees, MD, MPH

Fellow, Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts

Melanie Brooke Bernhardt, PharmD

Assistant Professor, Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Texas Children’s Cancer and Hematology Centers, Houston, Texas

Elizabeth A. Camp, PhD

Statistician, Department of Pediatrics Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas

Jessica S. Lin, BA

Medical Student, Baylor College of Medicine, Houston, Texas

Corrie E. Chumpitazi, MD, MS

Associate Professor, Department of Pediatrics Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas

References

Chen BK, Hibbert J, Cheng X, et al.: Travel distance and sociodemographic correlates of potentially avoidable emergency department visits in California, 2006-2010: An observational study. Int J Equity Health. 2015; 14: 30.

Cintron A, Morrison RS: Pain and ethnicity in the United States: A systematic review. J Palliat Med. 2006; 9(6): 1454-1473.

Todd KH, Deaton C, D'Adamo AP, et al.: Ethnicity and analgesic practice. Ann Emerg Med. 2000; 35(1): 11-16.

Pletcher MJ, Kertesz SG, Kohn MA, et al.: Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008; 299(1): 70-78.

Jimenez N, Anderson GD, Shen DD, et al.: Is ethnicity associated with morphine's side effects in children? Morphine pharmacokinetics, analgesic response, and side effects in children

having tonsillectomy. Paediatr Anaesth. 2012; 22(7): 669-675. 6. Cepeda MS, Farrar JT, Roa JH, et al.: Ethnicity influences morphine pharmacokinetics and pharmacodynamics. Clin Pharmacol Ther. 2001; 70(4): 351-361.

Palmer SN, Giesecke NM, Body SC, et al.: Pharmacogenetics of anesthetic and analgesic agents. Anesthesiology. 2005; 102(3): 663-671.

Tobias JD, Green TP, Coté CJ, et al.: Codeine: Time to say “no”. Pediatrics. 2016; 138(4): e1-e7.

US Department of Justice, Drug Enforcement Administration: Schedules of controlled substances: Rescheduling of hydrocodone combination products from schedule III to schedule II. August 22, 2014. Available at https://www.deadiversion.usdoj.gov/fed_regs/rules/2014/fr0822.htm. Accessed January 8, 2018.

Chumpitazi CE, Rees CA, Camp EA, et al.: Decreased opioid prescribing in a pediatric emergency department after the rescheduling of hydrocodone. J Emerg Med. 2017; 52(4): 547-553.

Texas Medical Board: Healthcare provider search input. Available at https://public.tmb.state.tx.us/HCP_Search/SearchNotice.aspx. Accessed January 8, 2018.

The White House of the United States of America: Classification of federal data on race and ethnicity. Washington, DC: Executive Office of the President Office of Management and Budget, August 28, 1995. Available at https://www.whitehouse.gov/wp-content/uploads/2017/11/fedreg_race-ethnicity.pdf. Accessed January 8, 2018.

Mills AM, Shofer FS, Boulis AK, et al.: Racial disparity in analgesic treatment for ED patients with abdominal or back pain. Am J Emerg Med. 2011; 29(7): 752-756.

Tamayo-Sarver JH, Hinze SW, Cydulka RK, et al.: Racial and ethnic disparities in emergency department analgesic prescription. Am J Public Health. 2003; 93(12): 2067-2073.

Caperell K, Pitetti R, Cross KP: Race and acute abdominal pain in a pediatric emergency department. Pediatrics. 2013; 131(6): 1098-1106.

Goyal MK, Kuppermann N, Cleary SD, et al.: Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. 2015; 169(11): 996-1002.

Green CR, Anderson KO, Baker TA, et al.: The unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain Med. 2003; 4(3): 277-294.

American Academy of Pediatrics: Demographics of women physicians and pediatricians. Available at https://www.aap.org/en-us/Documents/dwmep_women_med_demographics.pdf. Accessed January 19, 2017.

Dickason RM, Chauhan V, Mor A, et al.: Racial differences in opiate administration for pain relief at an academic emergency department. West J Emerg Med. 2015; 16(3): 372-380.

Jones CM, Lurie PG, Throckmorton DC: Effect of US drug enforcement administration's rescheduling of hydrocodone combination analgesic products on opioid analgesic prescribing. JAMA Intern Med. 2016; 176(3): 399-402.

Terrell KM, Hui SL, Castelluccio P, et al.: Analgesic prescribing for patients who are discharged from an emergency department. Pain Med. 2010; 11(7): 1072-1077.

Bradford LD: CYP2D6 allele frequency in European Caucasians, Asians, Africans and their descendants. Pharmacogenomics. 2002; 3(2): 229-243.

Cascorbi I: Pharmacogenetics of cytochrome p4502D6: Genetic background and clinical implication. Eur J Clin Invest. 2003; 33(suppl 2): 17-22.

Vila D, Rand CS, Cabana MD, et al.: Disparities in asthma medication dispensing patterns: The case of pediatric asthma in Puerto Rico. J Asthma. 2010; 47(10): 1136-1141.

Published

05/01/2019

How to Cite

Rees, MD, MPH, C. A., M. B. Bernhardt, PharmD, E. A. Camp, PhD, J. S. Lin, BA, and C. E. Chumpitazi, MD, MS. “Race and Ethnicity: Not Factors in the Prescribing of Hydrocodone- and Codeine-Containing Products in Two Pediatric Emergency Departments”. Journal of Opioid Management, vol. 15, no. 3, May 2019, pp. 229-33, doi:10.5055/jom.2019.0506.

Issue

Section

Articles