Racial/ethnic differences in prevalence of opioid and non-opioid treatments for pain in Medicaid

Abstract More than 1 in 5 U.S. adults experience chronic pain. Management of chronic pain has shifted from opioids to non-opioid pharmacologic and non-pharmacologic alternatives. This study compared the opioid and non-opioid pain treatments received in the outpatient setting among adult Medicaid beneficiaries of different racial/ethnic groups and pain/disability conditions from 2016–2019. We conducted a cross-sectional study to estimate annual proportions of Medicaid beneficiaries who received pain treatment, by racial/ethnic group, treatment type, and chronic pain/disability status, using the Medicaid T-MSIS Analytic Files. We focused on 24 states that implemented Medicaid expansion under the Affordable Care Act in or prior to 2014, and included 1,276,457 Medicaid beneficiaries with chronic pain or chronic pain and disability, ages 18–64. The proportion prescribed opioids decreased from 54.8% in 2016 to 40.3% in 2019 across all race, ethnicity, and pain/disability strata. Asian beneficiaries were prescribed opioids at the lowest rate (19.0%), while White beneficiaries had the highest (51.3%). Physical therapy, acupuncture, chiropractic work, and procedural interventions rose from 18.3%, 0.4%, 5.0%, and 9.9%, respectively, in 2016 to 21.0%, 1.2%, 6.0%, and 12.4% in 2019. White beneficiaries had the highest rates of chiropractic work and procedural interventions, while Asian beneficiaries had the highest rate of acupuncture. Although Medicaid expanded access to non-pharmacologic treatments, substantial racial/ethnic disparities in pain treatment remain. Future efforts to address chronic pain in the United States must prioritize a patient-centered approach that addresses structural drivers of racial/ethnic disparities in treatment access.