An expert from Dana-Farber Cancer Institute states that although giving opioids for minor procedures could lead to substance abuse issues, use of the drugs to manage end of life cancer pain should not be up for debate.
It is “difficult” to defend the decreased access to prescription opioids some racial and ethnic minority patients with cancer face near the end of life, especially when examining access by gender, according to Andrea C. Enzinger, MD.
In an interview with CancerNetwork®, Enzinger, an assistant professor of medicine at Harvard Medical School and medical oncologist at Dana-Farber Cancer Institute, spoke about how Black men in particular were less likely to fill any end of life opioid prescriptions and long-acting opioids vs White men.
Moreover, when their prescriptions were filled, Black patients received 300 morphine milligram equivalents less than their White counterparts.
Coming into this study, we did expect to see disparities in access because they’ve been shown across conditions and settings such as among pediatric populations, patients with fractures, [or] for post-operative pain. What is startling to us is that this is really the emblematic population where you would hope to never see disparities among people who are dying.
There are lots of downsides to prescription opioids, and one could argue that maybe it’s a good thing that we’re not giving as many opioid pain medications in settings such as post-tooth extractions where prescribing opioids can lead to problems like substance abuse and addiction. But these are dying patients, so it’s difficult to defend any degree of disparities and especially the magnitude that we saw.
Another surprising and disconcerting finding was that we saw huge variation if you drilled down by patient characteristics beyond just race and ethnicity, particularly when you look at the interaction between patient’s gender and their race.
Black men were dramatically more affected by disparities in opioid access compared with any other group. If you look, for example, at the difference between White men and Black men in access to any prescription opioid, Black men were about 6 percentage points less likely to fill any opioid in the last month of life. They were more than 4 percentage points less likely to fill a long-acting opioid. If you look at the difference in total dose, they filled about 300 morphine milligram equivalents less than White men in the last month of life. All of the disparities were magnified substantially when you looked at Black men.
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