Abstract：
BACKGROUND: The 2022 Centers for Disease Control\'s \"Clinical Practice Guidelines for Prescribing Opioids for Pain in United States\" called for attention and action toward reducing disparities in untreated and undertreated pain among Black and Latino patients. There is growing evidence for controlled substance safety committees (CSSC) to change prescribing culture, but few have been examined through the lens of health equity. We examined the impact of a primary care CSSC on opioid prescribing, including by patients\' race and sex.
METHODS: We conducted a retrospective cohort study. Our primary outcome was a change in prescribed morphine milligram equivalents (MME) at baseline (2017) and follow-up (2021). We compared the differences in MME by race and sex. We also examined potential intersectional disparities. We used paired t test to compare changes in mean MME\'s and logistic regression to determine associations between patient characteristics and MME changes.
RESULTS: Our cohort included 93 patients. The mean opioid dose decreased from nearly 200 MME to 136.1 MME, P < .0001. Thirty percent of patients had their dose reduced to under 90 MME by follow-up. The reduction rates by race or sex alone were not statistically significant. There was evidence of intersectional disparities at baseline. Black women were prescribed 88.5 fewer MME\'s at baseline compared with their White men counterparts, P = .04.
CONCLUSIONS: Our findings add to the previously documented success of CSSCs in reducing opioid doses for chronic nonmalignant pain to safer levels. We highlight an opportunity for primary care based CSSCs to lead the efforts to identify and address chronic pain management inequities.
METHODS: We conducted a retrospective cohort study. Our primary outcome was a change in prescribed morphine milligram equivalents (MME) at baseline (2017) and follow-up (2021). We compared the differences in MME by race and sex. We also examined potential intersectional disparities. We used paired t test to compare changes in mean MME\'s and logistic regression to determine associations between patient characteristics and MME changes.
RESULTS: Our cohort included 93 patients. The mean opioid dose decreased from nearly 200 MME to 136.1 MME, P < .0001. Thirty percent of patients had their dose reduced to under 90 MME by follow-up. The reduction rates by race or sex alone were not statistically significant. There was evidence of intersectional disparities at baseline. Black women were prescribed 88.5 fewer MME\'s at baseline compared with their White men counterparts, P = .04.
CONCLUSIONS: Our findings add to the previously documented success of CSSCs in reducing opioid doses for chronic nonmalignant pain to safer levels. We highlight an opportunity for primary care based CSSCs to lead the efforts to identify and address chronic pain management inequities.
摘要：
背景：2022年疾病控制中心的“美国阿片类药物治疗疼痛的临床实践指南”呼吁关注和采取行动，以减少黑人和拉丁裔患者未经治疗和治疗不足的疼痛差异。越来越多的证据表明，受控物质安全委员会(CSSC)改变处方文化，但很少有人从健康公平的角度进行研究。我们检查了初级保健CSSC对阿片类药物处方的影响，包括患者种族和性别。
方法：我们进行了一项回顾性队列研究。我们的主要结果是基线（2017）和随访（2021）时处方吗啡毫克当量（MME）的变化。我们按种族和性别比较了MME的差异。我们还研究了潜在的交叉差异。我们使用配对t检验比较平均MME的变化和逻辑回归来确定患者特征和MME变化之间的关联。
结果：我们的队列包括93例患者。平均阿片类药物剂量从近200个MME下降到136.1个MME，P<.0001。通过随访，30%的患者的剂量降至90以下。仅按种族或性别划分的下降率无统计学意义。基线时存在交叉差异的证据。与白人男性相比，黑人女性在基线时的MME处方减少了88.5，P=.04。
结论：我们的发现增加了先前记录的CSSCs在将慢性非恶性疼痛的阿片类剂量降低到更安全水平方面的成功。我们强调基于初级保健的CSSC有机会领导识别和解决慢性疼痛管理不平等的努力。
方法：我们进行了一项回顾性队列研究。我们的主要结果是基线（2017）和随访（2021）时处方吗啡毫克当量（MME）的变化。我们按种族和性别比较了MME的差异。我们还研究了潜在的交叉差异。我们使用配对t检验比较平均MME的变化和逻辑回归来确定患者特征和MME变化之间的关联。
结果：我们的队列包括93例患者。平均阿片类药物剂量从近200个MME下降到136.1个MME，P<.0001。通过随访，30%的患者的剂量降至90以下。仅按种族或性别划分的下降率无统计学意义。基线时存在交叉差异的证据。与白人男性相比，黑人女性在基线时的MME处方减少了88.5，P=.04。
结论：我们的发现增加了先前记录的CSSCs在将慢性非恶性疼痛的阿片类剂量降低到更安全水平方面的成功。我们强调基于初级保健的CSSC有机会领导识别和解决慢性疼痛管理不平等的努力。
