Abstract
OBJECTIVE: The aim of the current study was to determine whether and how physicians' use of opioid stewardship (OS) strategies and nonopioid, multimodal treatments differed by patient race and prior opioid misuse behaviors for patients with chronic pain. METHOD: Physicians (N = 135) made pain care decisions for eight virtual patients with chronic pain who varied by race (Black, White) and prior opioid misuse behaviors (adherent, misuse). For each patient, physicians indicated their use of OS strategies (agonist medication, urine drug testing, prescription drug monitoring, opioid contract, and naloxone rescue kit) and nonopioid treatments (nonopioid analgesics and nonpharmacological treatments; e.g., cognitive behavioral therapy, acupuncture, and chiropractic), referral to physical therapy, referral to pain specialty clinic, and referral to substance abuse clinic. RESULTS: In terms of patient race, physicians were more likely to use opioid contracts for Black versus White patients and were more likely to refer Black versus White patients to a pain specialty clinic. In terms of patient misuse behaviors, physicians were more likely to implement all OS strategies and were more likely to initiate referrals to pain specialty and substance abuse clinics for patients with prior opioid misuse versus prior adherence. Conversely, physicians were less likely to prescribe nonopioid analgesics and physical therapy for patients with prior opioid misuse versus prior adherence. There were no significant Patient Race × Opioid Misuse interactions. CONCLUSIONS: These results inform future research and interventions to enhance pain equity and improve pain care for patients who are made vulnerable by their racial identities and stigmatized behaviors. (PsycInfo Database Record (c) 2025 APA, all rights reserved).