Racial Inequality in Prescription Opioid Receipt — Role of Individual Health Systems

Nancy E. Morden
Deanna Chyn
Andrew Wood
Ellen Meara
Peer-Reviewed Article
July 2021


Analysis of 310 health systems showed gaps in opioid receipt between Black and white patients, especially on dosage, which may be related to racial bias among clinicians.


Black and Hispanic individuals are less likely than white patients to be prescribed opioid analgesics. This disparity has been attributed to myths about the relationship between race and pain perceptions and management. This study compares opioid receipt among Black and non-Hispanic white Medicare beneficiaries with disability across and within health systems using Medicare claims data from 2016 and 2017.


Although the annual prevalence of prescription opioid receipt was similar among Black and white patients across a national sample of 310 health systems, there were gaps within individual health systems on opioid receipt between Black and white patients. In 75 percent of the health systems analyzed, white patients received opioid doses that were at least 15 percent higher than doses prescribed to Black patients. The study also identified disparities in the long-term receipt group — individuals who receive opioids for extended periods of time — with lower annual rates of long-term opioid receipts and smaller doses among Black patients as compared to white patients. System-specific reporting with crude opioid measures on each of the 310 health systems is available in Appendix 2 of this article.


These findings may indicate conscious or unconscious racial bias among clinicians, such that Black patients experience less pain or are more likely to misuse opioids than white patients. Health systems, providers, and policymakers should seek to better understand and address racial inequities in prescription opioid receipt.

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