Provider and patient sex disparities in opioid prescribing and patient outcomes

Christa Coleman, PsyD, MSCP; Robert P. Lennon, MD, JD; James M. Robinson, PhD; Wen-Jan Tuan, DHA, MPH, MS; Nalini Sehgal, MD; Aleksandra E. Zgierska, MD, PhD

doi:10.5055/jom.2022.0737

Authors

Christa Coleman, PsyD, MSCP https://orcid.org/0000-0003-4255-5592
Robert P. Lennon, MD, JD
James M. Robinson, PhD
Wen-Jan Tuan, DHA, MPH, MS
Nalini Sehgal, MD
Aleksandra E. Zgierska, MD, PhD

DOI:

https://doi.org/10.5055/jom.2022.0737

Keywords:

opioid, pain, sex disparities

Abstract

Objective: To assess sex disparities in opioid prescribing practices and patient outcomes.

Design: A retrospective cross-sectional study.

Setting: Thirty-three primary care clinics in an academic health system.

Participants: 2,738 adults prescribed 10+ outpatient opioid prescriptions within 12 months.

Main outcome measure(s): Patient and primary care provider (PCP) sex-based differences in clinical outcomes, opioid prescribing, and rates of adherence to guideline-concordant opioid prescribing practices.

Results: Female PCPs were more likely (p < 0.001) to prescribe lower morphine-equivalent daily dose (MEDD) of opioids and complete risk assessment for opioid misuse than male PCPs. PCPs did not differ by sex in adherence rates to controlled substance agreements, urine drug, depression screening, or opioid-benzodiazepine coprescribing.

Female patients were more likely (all p ≤ 0.01) to be screened for opioid misuse, treated with lower MEDD, receive opioid-benzodiazepine coprescriptions, have higher pain interference, anxiety and depression diagnoses, and have an overdose diagnosis; they were less likely (all p < 0.001) to report alcohol use or have an alcohol use disorder diagnosis and utilized health care at higher rates than male patients.

Conclusions: Sex differences were found in clinician opioid-prescribing practices and adherence to opioid prescribing guidelines and patient characteristics associated with long-term opioid therapy. Strategies to identify sex-related disparities and enhance guideline-concordant opioid prescribing and monitoring could contribute to improved patient care, and clinical and safety outcomes.

Author Biographies

Christa Coleman, PsyD, MSCP

Assistant Professor, Departments of Psychiatry and Behavioral Health and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania

Robert P. Lennon, MD, JD

Associate Professor, Department of Family and Community Medicine, Penn State College of Medicine, Affiliate Faculty, Penn State Law, University Park, Pennsylvania

James M. Robinson, PhD

Center for Health Systems Research and Analysis, University of Wisconsin-Madison, Madison, Wisconsin

Wen-Jan Tuan, DHA, MPH, MS

Assistant Professor, Department of Family and Community Medicine, and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania

Nalini Sehgal, MD

Professor, Department of Orthopedic & Rehabilitation Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin

Aleksandra E. Zgierska, MD, PhD

Professor, Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania

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