Clinicians tend to prescribe lower doses of opioids to minority patients for pain control,66 including minority children.67 While clinical confounds may partly explain this phenomenon, a similar pattern is observed in the setting of substance use disorders: OD treatment programs serving a higher proportion of AA patients are more likely to report under-dosing of methadone.51 We observed lower opioid doses for AAs compared to EAs (methadone: t-test P < 0.001; morphine: t-test P < 0.001). The present data are therefore consistent with the hypothesis that prescriber bias may contribute to differences between population groups in the quantity of opioids dispensed, although we cannot exclude the possibility that the observed differences in dosing may reflect actual differences in medication requirements.68 If EA subjects are dosed more liberally than AA subjects, who receive doses closer to the therapeutic minimum or are undertreated, objective markers to guide dosing could serve to mitigate under-dosing and consequent health disparities.
