Racial Disparities in Opioid Prescribing: A New Study Highlights Risks for Black Patients

In a groundbreaking study, researchers have uncovered significant racial disparities in opioid prescribing practices within emergency departments, revealing that Black patients are less likely to receive opioid prescriptions and more likely to misuse opioids later as a result. Conducted across six emergency departments at four academic medical centers, the study highlights the critical impact of unmet pain treatment preferences on future opioid misuse, particularly among Black patients.

The research, published in the Journal of General Internal Medicine, involved 735 participants and utilized the Current Opioid Misuse Measure (COMM) to assess misuse risk 90 days post-visit. The findings indicate that Black patients, whose preferences for opioid treatment were unmet, reported higher misuse risks compared to their white counterparts. This disparity underscores the need for equitable pain management strategies in healthcare settings.

Understanding the Disparities in Pain Management

The study’s results challenge the prevailing notion that reducing opioid prescriptions universally leads to safer outcomes. Instead, it suggests that ignoring patient preferences, especially in the context of racial disparities, can exacerbate the risk of opioid misuse. The study found that 21.8% of Black participants experienced unmet opioid treatment preferences, compared to 15% of white participants.

“While a great deal of studies on opioid misuse focus on overprescribing, this study flips the script by showing that under-prescribing —or more precisely, ignoring a patient’s pain treatment preferences —can also lead to harmful outcomes, especially when patients are dissatisfied with their care,” said Dr. Max Jordan Nguemeni, the study’s lead author.

The Role of Patient Satisfaction

Patient satisfaction emerged as a crucial factor influencing opioid misuse risk. The study found that Black patients with unmet treatment preferences and low satisfaction scores had nearly double the COMM scores of their white counterparts. However, when satisfaction was high, this racial gap in misuse risk disappeared, highlighting the importance of patient experience in pain management.

This development follows a broader conversation about healthcare equity and the need to address systemic biases that affect patient outcomes. The study’s findings are particularly relevant given the disproportionate rates of opioid overdose deaths in Black communities, which have often been attributed to untreated pain and unmet healthcare expectations.

Implications for Healthcare Practices

The implications of these findings are significant for healthcare providers and policymakers. The study suggests a need for more nuanced approaches to pain management that consider patient preferences and satisfaction, particularly for marginalized groups. This could involve strategies such as shared decision-making and building trust between patients and providers.

According to Dr. Eden Engel-Rebitzer, a co-author of the study, “Addressing these disparities requires a comprehensive understanding of the factors that influence patient satisfaction and their subsequent impact on opioid misuse risk.”

Future Research Directions

Looking ahead, the research team plans to explore the underlying reasons why some patients report lower satisfaction with their pain care. Future studies will investigate factors such as communication dynamics, cultural competence, and systemic biases that may contribute to these disparities.

The next step is to examine why some patients feel less satisfied with their pain care than do others. Future research will explore factors shaping patients’ satisfaction with pain care and their impact on opioid misuse risk, such as shared decision-making and patient-provider trust.

About the Study and Research Team

The study, titled “Racial Disparities in Unmet Pain Treatment Preference, Pain Treatment Satisfaction and Subsequent Opioid Misuse: A Secondary Analysis of a National Multisite RCT,” was published online on June 25, 2025. The research was funded by the Patient Centered Outcomes Research Institute and involved a team of experts from institutions including Brigham & Women’s Hospital, the University of Pennsylvania, and Vanderbilt University.

The move represents a significant step forward in understanding the complex interplay between race, patient satisfaction, and opioid misuse, offering a new perspective on addressing the opioid crisis through equitable healthcare practices.

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