Patients who legitimately need opioid painkillers are finding it more difficult to get the meds they need, due to guardrails established in response to the U.S. opioid crisis, a new study says.
Doctors who treat patients in severe pain said they frequently encounter obstacles when prescribing opioid painkillers, researchers reported in the journal NEJM Catalyst Innovations In Care Delivery.
“The opioid crisis of overdose deaths remains omnipresent; however, a new threat has emerged among vulnerable populations who need these medicines as first-line treatment for their pain, which can be severe,” lead researcher Dr. Rebecca Rodin said in a news release. Rodin is an assistant professor of geriatrics and palliative medicine at the Icahn Mount School of Medicine at Mount Sinai in New York City.
Opioids are sometimes needed to counter severe pain in patients with cancer or conditions like sickle cell, researchers said in background notes.
However, more than 720,000 people have died in the U.S. since 1999 from opioid overdoses, in an ongoing crisis that led policymakers to tighten opioid prescribing methods.
To see how these restrictions have affected treatment, researchers surveyed 52 palliative care doctors and nurses within the Mount Sinai Health System.
Results showed that:
- 88% reported frequent access issues with opioid meds.
- 80% changed their opioid up to half the time prescribing due to limited availability of opioid drugs.
- 31% said these access issues got in the way of proper pain control.
- Clinical teams spend more than an hour every day on the phone with insurance companies and pharmacies, ironing out problems.
A major problem is the scattered and uneven availability of opioids among pharmacies, researchers reported.
“Our clinicians told us that in New York City’s outer boroughs, such as the Bronx, Brooklyn, and Queens, they encountered much greater difficulty obtaining opioids where we treat higher concentrations of underrepresented patients who are socioeconomically vulnerable,” Rodin said.
Mount Sinai doctors have tried a three-pronged approach to make opioid meds more available to those in need, researchers say.
First, they reached out to key pharmacies to explain why these painkillers are needed and the importance of keeping them in stock.
The team also developed education programs for providers to explain when and why opioid painkillers are necessary, the study says.
And finally, the team crafted a guide to preferred pharmacies so that doctors will know where to turn when opioids are needed during a pain crisis.
“Our strategies have been effective within the Mount Sinai ecosystem, but they do not address root causes of barriers which can include a number of factors, such as much broader supply chain shortages at the regional and national level, public and private coverage policies, and pharmacy stocking and dispensing practices,” Rodin said. “We need to do more to address these barriers.”
How opioid restrictions affect Black patients
Racial discrimination significantly impacts how Black Americans receive opioids in several interconnected ways:
Under-prescription for pain:
- Racial bias and false beliefs: A disturbing number of healthcare professionals hold false beliefs about biological differences between Black and White individuals, including the misconception that Black people have a higher pain tolerance or that their skin is thicker. These biases lead to underestimation of pain reported by Black patients.
- Lower likelihood of receiving pain medication: Studies have consistently shown that Black patients are less likely to receive opioid prescriptions for pain compared to White patients with similar conditions and pain levels. This disparity exists across various settings, including emergency departments, surgical settings, and primary care.
- Shorter duration and lower doses: Even when Black patients are prescribed opioids, they often receive them for shorter durations and at lower doses compared to White patients.
Disparities in opioid use disorder (OUD) treatment:
- Less likely to receive medication-assisted treatment (MAT): Black individuals with OUD are less likely to receive evidence-based MAT like buprenorphine, which is a life-saving treatment that reduces overdose risk.
- Lower treatment completion rates: Black patients have the lowest treatment completion rates for OUD compared to other racial and ethnic groups.
- Barriers to access: Factors like lack of insurance, transportation, and childcare disproportionately affect Black individuals, creating barriers to accessing OUD treatment.
- Mistrust and stigma: Historical mistreatment and discrimination within the healthcare system can lead to mistrust of medical professionals and treatment programs among Black communities. Stigma associated with opioid use and treatment can also be a significant barrier.
- Unequal access to buprenorphine: Historically, buprenorphine was less accessible in public healthcare settings and segregated Black neighborhoods, limiting access for many Black individuals with OUD.
Increased scrutiny and suspicion:
- Higher rates of drug testing: Studies have shown that Black patients, even those with legitimate pain from conditions like cancer, are more likely to undergo urine drug screenings, potentially reflecting suspicion of drug-seeking behavior.
- More likely to have opioids discontinued: Healthcare providers are more likely to discontinue opioid prescriptions for Black patients compared to White patients if there’s any suspicion of misuse.
Racial discrimination manifests in various forms within the healthcare system, leading to both the under-treatment of pain and disparities in access to effective opioid use disorder treatment for Black Americans.
More information
The U.S. Centers for Disease Control and Prevention has more on appropriate prescriptions for opioids.
SOURCE: Icahn School of Medicine at Mount Sinai, news release, April 16, 2025