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Disparities in the Prescription of Opioids

JAMA Intern Med; ePub 2019 Feb 11; Friedman, et al

In the California health care system, race/ethnicity and income class disparities existing in access to opioids may have played a role in the race/ethnicity-income pattern of overdose deaths in the current opioid epidemic. This according to a population-based study that used 2011 through 2015 records from California’s prescription drug monitoring program, which longitudinally tracks all patients receiving controlled substance prescriptions in the state and contained unique records for nearly 30 million individuals who received such a prescription during this period. The primary outcome was the percentage of individuals receiving at least 1 prescription each year calculated for opioids, benzodiazepines, and stimulants. Researchers found:

  • A nearly 300% difference in opioid prescription prevalence across the race/ethnicity-income gradient was observed in California.
  • 44.2% of all adults in California in the regions with the lowest-income/highest proportion-white population received at least 1 opioid prescription annually vs 16.1% in the regions with the highest-income/lowest proportion-white population and 23.6% across California.
  • Opioid overdose deaths were concentrated in lower-income, mostly white regions of the state, with a 10-fold difference in overdose rates across the race/ethnicity-income gradient.


Friedman J, Kim D, Schneberk T, et al. Assessment of racial/ethnic and income disparities in the prescription of opioids and other controlled medications in California. [Published online ahead of print February 11, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.6721.