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opioids

24 June 2026
Emily Taylor
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Categories: Resource

Opioid Misuse Among American Indian Adolescents

Objectives. To present data for opioid misuse among US reservation-based American Indian (AI) adolescents and to compare these data with national rates from Monitoring the Future (MTF). Methods. Data were from a national sample of 33 schools participating in a substance use epidemiological survey of reservation-based AI adolescents during 2018 and 2019. Participants were 8th-, 10th-, and 12th-grade AI students (n = 1592). Measures included 12-month and 30-day use of OxyContin, Vicodin, heroin, and narcotics. We computed prevalence and compared it with MTF national prevalence. Results. Across grades, AI youths demonstrated significantly greater past 12-month and 30-day opioid use relative to a national sample. Significant absolute differences in 12-month and 30-day prevalence levels ranged from 1.6% (8th-grade heroin) to 4.7% (12th-grade narcotics) and from 1.6% (12th-grade narcotics) to 1.8% (12th-grade heroin), respectively. Conclusions. Opioid misuse prevalence levels were significantly greater for reservation-based AI adolescents relative to national prevalence levels. Public Health Implications. Findings suggest that implementation of evidence-based efforts, adapted or developed to be culturally appropriate, should be significantly increased in tribal communities, along with policies to address the unique social, economic, and health issues they face.

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24 June 2026
Emily Taylor
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Narrative Review of Opioid Use Disorder TreatmentChanges During the COVID-19 Pandemic and Their Impact on American Indian/Alaska Native Communitie

ABSTRACT

Background: The United States (US) declared drug overdose a public health emergency in 2017. Despite this, two million people reported having an opioid use disorder (OUD) in 2018. However, following the beginning of COVID-19 there was a 53% increase in overdose deaths, with American Indian/Alaska Native (AI/AN) individuals experiencing the highest rates of all racial groups. In response to the COVID-19 pandemic and OUD treatment access challenges, OUD treatment policies were changed to improving access to care. Purpose: This review examines how the state- and federal-level policies impacted access to medications for opioid use disorder (MOUD) during the COVID-19 pandemic. Due to the devastating impact of overdose and COVID-19 on AI/AN communities, as a secondary aim, we examined the inclusion of these populations in the samples of the included studies. Methods: We completed a narrative review using a data-based convergent synthesis design. Results: Forty-four studies met the inclusion criteria. Most of the studies were quantitative descriptive studies (n =25). Only two studies offer AI/AN as a category for ethnicity and both had less that 4% of the sample that identified as an AI/AN individual. Conclusion and Implications: Telehealth OUD treatment increased initiation and retention for patients taking buprenorphine. No increase in overdose rates was associated with allowing for additional take-home doses of methadone. However, access to treatment, even telehealth, remains difficult for individuals due to a lack of OUD treatment providers and access to the internet. More needs to be done to address the opioid overdose crisis, especially among AI/AN communities. Research focused on cultural strategies to address this health disparity is desperately needed. We included nursing implications in response to this health disparity among AI/AN individuals.

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18 June 2026
Emily Taylor
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Complementary Alternative Medicine: A Culturally Centered Approach to Managing Chronic Pain from One American Indian Community

Abstract: This evaluation explored the benefits of Complementary Alternative Medicine (CAM) within a reservation-based, State-certified outpatient treatment provider. The three CAM strategies provided were massage, acupuncture, and chiropractic therapies. The evaluation team worked with a peer recovery support specialist and tribal evaluation intern to co-create a one-page, eight-question, fixed-response instrument based on previous work in the community. Surveys were collected by the peer support specialist post-session with individuals receiving CAM therapies. Surveys assessed self-reported impacts, reasons for attending CAM sessions, and mental, physical, spiritual, and emotional health before and after CAM sessions. Paired t-tests were used to examine significant differences in mean scores before and after CAM sessions. A total of 40 participants completed the survey between March 2021 and March 2022. The evaluation found a significant increase in the mean scores for all measured self-reported health ratings: physical, spiritual, emotional, and mental. The greatest increase observed was for physical health (M = 5.32, SD = 2.53) and physical health after (M = 8.38, SD = 1.60) based on self-report data; t(78) = 6.46, p = .0001. CAM sessions positively influenced participants; 83% (n = 33) reported being more hopeful about their overall health and wellness. The holistic approach demonstrated promising results and potential benefits of CAM on overall wellness and belonging. Further research is needed to explore how CAM may be implemented as a culturally centered approach to managing chronic pain often associated with opioid use disorder.

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16 June 2026
Emily Taylor
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Racial, Ethnic, and Language-Based Inequities in Inpatient Opioid Prescribing by Diagnosis from Internal Medicine Services, a Retrospective Cohort Study

Introduction. Opioid administration is extremely common in the inpatient setting, yet we do not know how the administration of opioids varies across different medical conditions and patient characteristics on internal medicine services. Our goal was to assess racial, ethnic, and language-based inequities in opioid prescribing practices for patients admitted to internal medicine services. Methods. We conducted a retrospective cohort study of all adult patients admitted to internal medicine services from 2013 to 2021 and identified subcohorts of patients treated for the six most frequent primary hospital conditions (pneumonia, sepsis, cellulitis, gastrointestinal bleed, pyelonephritis/urinary tract infection, and respiratory disease) and three select conditions typically associated with pain (abdominal pain, acute back pain, and pancreatitis). We conducted a negative binomial regression analysis to determine how average administered daily opioids, measured as morphine milligram equivalents (MMEs), were associated with race, ethnicity, and language, while adjusting for additional patient demographics, hospitalization characteristics, medical comorbidities, prior opioid therapy, and substance use disorders. Results. The study cohort included 61,831 patient hospitalizations. In adjusted models, we found that patients with limited English proficiency received significantly fewer opioids (66 MMEs, 95% CI: 52, 80) compared to English-speaking patients (101 MMEs, 95% CI: 91, 111). Asian (59 MMEs, 95% CI: 51, 66), Latinx (89 MMEs, 95% CI: 79, 100), and multi-race/ethnicity patients (81 MMEs, 95% CI: 65, 97) received significantly fewer opioids compared to white patients (103 MMEs, 95% CI: 94, 112). American Indian/Alaska Native (227 MMEs, 95% CI: 110, 344) patients received significantly more opioids. Significant inequities were also identified across race, ethnicity, and language groups when analyses were conducted within the subcohorts. Most notably, Asian and Latinx patients received significantly fewer MMEs and American Indian/Alaska Native patients received significantly more MMEs compared to white patients for the top six most frequent conditions. Most patients from minority groups also received fewer MMEs compared to white patients for three select pain conditions. Discussion. There are notable inequities in opioid prescribing based on patient race, ethnicity, and language status for those admitted to inpatient internal medicine services across all conditions and in the subcohorts of the six most frequent hospital conditions and three pain-associated conditions. This represents an institutional and societal opportunity for quality improvement initiatives to promote equitable pain management.

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16 June 2026
Kase Cragg
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Examining Racial, Ethnic, and Gender Disparities in the Treatment of Pain and Injury Emergencies

Background: Racial, ethnic, and gender disparities in effective pain management have been well-documented across healthcare settings. However, discrepancies in the treatment of patients in prehospital pain management settings have not been well researched. The objective of this study was to determine whether Wyoming emergency medical service (EMS) providers’ use of opioids to treat prehospital pain or injury varies by patient race/ethnicity or gender. Methods: This cross-sectional study of EMS records examined 27 448 patient care reports (PCRs) generated during emergency medical responses to pain/injury emergencies in the state of Wyoming between January 2016 and March 2019. We included PCRs in the sample when 1) the primary impression was pain or injury, 2) the type of service was a 911 response, 3) the patient received treatment from and was transported by the EMS unit completing the PCR, and 4) the responding unit included one or more providers authorized to administer opioids. Results: The analysis identified a disparity in opioid administration by EMS providers during emergency transport (N = 27 448). Logistic regression reveals that EMS providers administered opioids to American Indian/Alaska Native patients (AI/AN) [n = 1610; 5.9%; P < .001; OR = 0.44] and those of Hispanic ethnicity (n = 1351; 4.9%; P = .001; OR = 0.74) at statistically significant lower rates (n = 14 769; 53.8%; P = .004; OR = 0.90) than they administer opioids to White patients. The analysis found EMS providers administer opioids to females at significantly lower rates (P = .004) compared to males.

Conclusion: Wyoming EMS providers administer opioids to White and male patients more often than non-White and female patients. Our results do not show a significant difference in the administration of opioids between White and Black patients. However, the data indicate a statistically significant difference between Hispanic, AI/AN, and White patients as well as between male and female patients.

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16 June 2026
Kase Cragg
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Opioid and High-Risk Prescribing Among Racial and Ethnic Minority Veterans

Abstract: The purpose of this study is to compare opioid prescribing and high-risk prescribing by race and ethnicity in a national cohort of U.S. veterans.

Methods: A cross-sectional analysis of veteran characteristics and healthcare use was performed on electronic health record data for 2018 Veterans Health Administration users and enrollees in 2022.

Results: Overall, 14.8% received an opioid prescription. The adjusted odds of being prescribed an opioid were lower for all race/ethnicity groups than for non-Hispanic White veterans, except for non-Hispanic multiracial (AOR=1.03; 95% CI=0.999, 1.05) and non-Hispanic American Indian/Alaska Native (AOR=1.06; 95% CI=1.03, 1.09) veterans. The odds of any day of overlapping opioid prescriptions (i.e., opioid overlap) were lower for all race/ethnicity groups than for the non-Hispanic White group, except for the non-Hispanic American Indian/Alaska Native group (AOR=1.01; 95% CI=0.96, 1.07). Similarly, all race/ethnicity groups had lower odds of any day of daily dose >120 morphine milligram equivalents than the non-Hispanic White group, except for the non-Hispanic multiracial (AOR=0.96; 95% CI=0.87, 1.07) and non-Hispanic American Indian/Alaska Native (AOR=1.06; 95% CI=0.96, 1.17) groups. Non-Hispanic Asian veterans had the lowest odds for any day of opioid overlap (AOR=0.54; 95% CI=0.50, 0.57) and daily dose >120 morphine milligram equivalents (AOR=0.43; 95% CI=0.36, 0.52). For any day of opioid-benzodiazepine overlap, all races/ethnicities had lower odds than non-Hispanic White. Non-Hispanic Black/African American (AOR=0.71; 95% CI=0.70, 0.72) and non-Hispanic Asian (AOR=0.73; 95% CI=0.68, 0.77) veterans had the lowest odds of any day of opioid-benzodiazepine overlap.

Conclusions: Non-Hispanic White and non-Hispanic American Indian/Alaska Native veterans had the greatest likelihood to receive an opioid prescription. When an opioid was prescribed, high-risk prescribing was more common in White and American Indian/Alaska Native veterans than in all other racial/ethnic groups. As the nation’s largest integrated healthcare system, the Veterans Health Administration can develop and test interventions to achieve health equity for patients experiencing pain.

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15 June 2026
Kase Cragg
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Opioid Use Disorder and Racial/Ethnic Health Disparities: Prevention and Management

Abstract: This review aims to summarize risks and disparities associated with the prevalence and treatment of opioid use disorder in the perioperative and long-term setting, as well as evidence-based treatment and prevention targeted toward specific vulnerable populations.

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11 May 2026
Kase Cragg
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Disparities in Prehospital Non-Traumatic Pain Management

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While prior research has identified racial disparities in prehospital analgesia for traumatic pain, little is known about non-traumatic pain. Using a national prehospital dataset, we sought to evaluate for racial and ethnic disparities in analgesia given by EMS for non-traumatic pain.

Methods

We analyzed the 2018 and 2019 data from the ESO Data Collaborative, a collection of de-identified prehospital electronic health records from nearly 1,300 participating EMS agencies in the US. We included all transported, adult, non-traumatic encounters with a primary or secondary impression of a pain complaint, and we stratified encounters based on race and ethnicity as recorded by the EMS clinicians. We performed a mixed model analysis, modeling EMS agency as a random intercept and adjusting for age, sex, pain location, level of service, location of incident, and highest pain score. With non-Hispanic White patients as the reference group, we then evaluated the association between race/ethnicity and receiving any pain medication (acetaminophen, non-steroidal anti-inflammatories, or opioids), receiving opioid pain medication, and receiving pain medication within 20minutes of EMS arrival. Results: We included 1,035,486 patients; 67.5% non-Hispanic White, 26.8% Black, 4.9% Hispanic, 0.5% Asian, 0.1% Native Hawaiian or Other Pacific Islander, and 0.2% American Indian or Alaska Native patients. 4.7% of patients received pain medications. Compared to White patients (5.1%), Black patients were less likely to receive pain medication (3.3%, aOR 0.7; 95% CI 0.7-0.7) and Hispanics were more likely to receive pain medication (7.6%, aOR 1.5; 95% CI 1.4-1.6). Black patients were also less likely to receive opioids (1.8% for Black v 3.0% for White, aOR 0.7; 95% CI 0.6-0.7), while Hispanic patients were more likely to receive opioids (4.9%, aOR 1.4; 95% CI 1.3-1.5). The odds of receiving pain medication within 20minutes was lower for Black patients (aOR 0.9; 95% CI 0.8-0.95) but no different for Hispanic patients (aOR 1.0; 95% CI 0.9-1.1), when compared to White patients.

Conclusion: Pain medication administration is uncommon for non-traumatic pain complaints. While Black patients were less likely than White patients to receive pain medications and receive pain medication within 20minutes, Hispanics were more likely to receive pain medications.

Overdose Prevention Hub for Tribes and Native Communities

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The initiative for establishing an online one-stop native overdose prevention resource hub came about as one component of the U.S. Centers for Disease Control’s Opioid Overdose Prevention in Tribes. Learn More

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