Sex Differences in Opioid Prescribing Practices: Do Differences Exist in Therapeutic Treatment Between Men and Women Presenting to the Emergency Department with Low Back Pain?

Abstract

Objectives The primary objective of this study was to investigate sex/gender differences in the experiences of patients seeking pain management from the healthcare system through the comparison of their presentation, diagnosis, and treatment in and after a discharge from the Emergency Department (ED). The focus was patients experiencing low back pain, a frequently occurring condition, with a high likelihood of pain management treatment through opioids. Methods This study was a retrospective cohort design using health administrative data. I used data from two existing datasets. I considered sex and gender as the exposure variable, using the concept of entanglement. For my outcomes, I examined differences in the nature of the diagnosis and treatment in and after urgent care between men and women. I conducted descriptive statistics of demographic and clinical differences in men and women attending the ED. I then performed inferential analyses including logistic and linear regression modelling with clustering of patients. Results A total of 4 027 men and women attended the ED and data was available for 548 of these participants whether a prescription was administered in ED or was not. Women had a longer average stay than men, while men were more likely to be diagnosed with mechanical back pain. There were no significant differences in the odds of receiving opioids in ED between men and women. An adjusted logistic regression model found that men were more likely to fill a prescription than women (aOR for women: 0.72 [0.59,0.88]). There were no significant differences in doses or the nature of the prescription between men and women. Discussion This study provides information on sex differences in treatment of low back pain. While men were found to be more likely to fill prescriptions, this may be due to two potential explanations: men were more likely to fill a prescription at the pharmacy, or men were more likely to receive prescriptions in the ED. Understanding sex differences in what opioids men and women receive may lead to a better understanding of sex differences in the risk of developing problematic use of opioids. This research may help to inform policy when creating sex-specific prescribing practices for opioids in urgent care.