Black Patients Are Administered Opioid Pain Medications Less Often Than Hispanic and White Patients in the ED

Opioids are commonly administered or prescribed in the emergency department (ED) for pain management. The decision to administer or prescribe opioids typically depends on clinician assessment of the patient’s pain, which can be determined through verbal reports from the patient or clinical findings. In some patients, acute pain can cause temporary physiologic responses, such as increased pulse rate or systolic blood pressure, although vital signs have not been shown to reliably correlate with reported pain levels.¹

We analyzed 2.4 million ED encounters with pain-related chief complaints involving patients aged 30 to 39 from January 1, 2022, to February 29, 2024. We studied this age group as they are more likely than older patients to experience an acute pain event rather than a complex history of pain that might bring them to the ED. Our findings revealed that higher peak pulse rates and systolic blood pressure readings were generally associated with increased rates of opioid pain medication administrations during pain-related ED visits, regardless of the patient’s sex, race, or ethnicity. Despite this trend, Black patients consistently received opioids at lower rates compared to their Hispanic and White counterparts across most vital sign measurements, as seen in Figures 1 and 2. This pattern persisted among male and female patients and aligns with previous studies highlighting racial disparities in pain management in ED settings.²

Figure 1

Pulse Rate and ED Opioid Administrations

Figure 1. The rate of opioid administrations in pain-related ED encounters by patient race, ethnicity, and peak pulse rate.

Figure 2

Systolic Blood Pressure and ED Opioid Administrations

Figure 2. The rate of opioid administrations in pain-related ED encounters by patient race, ethnicity, and peak systolic blood pressure.

We also evaluated administration rates of non-opioid pain medications, such as acetaminophen, ibuprofen, ketorolac, and naproxen, in pain-related ED encounters. We found that Hispanic patients were administered non-opioid pain medications at a higher rate than Black and White patients. White patients were administered non-opioid pain medications least frequently across the range of peak pulse rates and systolic blood pressures, as seen in Figures 3 and 4. Of note, some of these medications may be administered for other purposes such as treating a fever, and indication for administration was not studied.

Figure 3

Pulse Rate and ED Non-Opioid Pain Medication Administrations

Figure 3. The rate of non-opioid pain medication administrations in pain-related ED encounters by patient race, ethnicity, and peak pulse rate.

Figure 4

Systolic Blood Pressure and ED Non-Opioid Pain Medication Administrations

Figure 4. The rate of non-opioid pain medication administrations in pain-related ED encounters by patient race, ethnicity, and peak systolic blood pressure.

Additionally, we wanted to understand whether these differences persisted for opioid prescriptions placed upon discharge from pain-related ED visits. While we found smaller differences in prescription rates among racial and ethnic groups, White patients, both male and female, had the highest discharge prescription rates for opioids across the range of peak pulse rates and systolic blood pressures, as seen in Figures 5 and 6.

Figure 5

Pulse Rate and ED Opioid Prescriptions

Figure 5. The rate of opioid prescriptions at discharge in pain-related ED encounters by patient race, ethnicity, and peak pulse rate.

Figure 6

Systolic Blood Pressure and ED Opioid Prescriptions

Figure 6. The rate of opioid prescriptions at discharge in pain-related ED encounters by patient race, ethnicity, and peak systolic blood pressure.

These findings underscore the need for better understanding of the factors contributing to racial disparities in opioid administration and discharge prescribing rates in emergency departments, with the goal of ensuring equitable pain management for all patients.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 256 million patient records from 1,500 hospitals and more than 34,100 clinics from all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

References

Shahiri T. S, Gélinas C. The validity of vital signs for pain assessment in critically ill adults: A narrative review. Pain Manag Nurs. 2023;24(3):318-328. doi:10.1016/j.pmn.2023.01.004
Lee P, Le Saux M, Siegel R, et al. Racial and ethnic disparities in the management of acute pain in US emergency departments: Meta-analysis and systematic review. The American Journal of Emergency Medicine. 9/2019;37(9):1770-1777.

Key Findings

References