Clinical question: Does patient sex influence opioid prescription patterns during hospitalization and at discharge on general medicine services?
Background: Clinicians may have sex- and gender-based biases in pain management, potentially leading to disparities in opioid prescriptions. Studies have shown that clinicians tend to underestimate pain in female patients.
Study design: Retrospective cohort study
Setting: Inpatient general medicine service at UCSF Helen Diller Medical Center in San Francisco
Synopsis: This retrospective cohort study analyzed opioid prescription patterns for 48,745 hospitalizations involving 27,777 patients at a large academic medical center from 2013 to 2021. 50.1% of hospitalized patients were female. When adjusted for demographic, clinical, and hospitalization-related variables, female patients were less likely to receive inpatient opioids (adjusted OR 0.87, P <0.001) and received fewer morphine milligram equivalents (MMEs) on average (27.46 fewer MMEs/day; P <0.001) compared to male patients. No significant differences were found in discharge opioid prescriptions (OR, 0.98; P=0.594). Subgroup analysis of common pain-related diagnoses (abdominal pain, acute back pain, pancreatitis) revealed similar trends. These findings suggest that while female patients report higher pain scores, they are often under-prescribed opioids during hospitalization. Limitations include reliance on sex rather than gender identity, potential confounding due to disease severity, and unaccounted pharmacological factors such as weight, body mass index, and renal function. These results highlight the need to address gender biases in pain management.
Bottom line: Despite higher pain scores, female patients are less likely to receive opioids, and when they do, they receive fewer MMEs than male patients during hospitalization, suggesting potential sex-based disparities in pain management.
Citation: Yang, N, et al. Sex disparities in opioid prescription and administration on a hospital medicine service. J Gen Intern Med. 2024;39(14):2679-2688. doi.org/10.1007/s11606-024-08814-7.
D
r. Damon is an academic hospitalist at the University of California Davis Medical Center, and internal medicine clerkship director and the hospital medicine track co-director for the internal medicine residency at the University of California Davis School of Medicine in Sacramento, Calif.