A new study examining racial disparities in unmet pain treatment finds that patients suffering from acute pain whose opioid treatment preferences were not met during an emergency department visit are at elevated risk for misusing them three months later. This was particularly true for Black patients, who were likelier than whites to be sent home without an opioid prescription. Patients who were satisfied with how their pain was managed in the emergency department were, however, less likely to misuse opioids, even if their preference for opioids was not honored.
Why it matters
The findings shed light on how disparities in pain treatment can increase the risk of future opioid misuse, especially for Black patients. The findings challenge the consensus view that lower opioid prescribing is always safer, highlighting the importance of patient experience and fairness in treatment. The study shines a light on a possibly overlooked cause for the disproportionate overdose deaths in Black communities: untreated pain and unmet expectations in the healthcare system.
The study
The researchers analyzed data on 735 participants collected from a randomized controlled trial conducted at six emergency departments at four academic medical centers. The primary outcome was opioid misuse risk as quantified by the Current Opioid Misuse Measure, or COMM, a 17-item, self-report measure of potential risk of misuse among people prescribed opioids for chronic pain that was taken 90 days after the patients' emergency department visit.
What they found
Unmet preference for opioid treatment was more common among Black participants (21.8%) compared to white participants (15%). At low satisfaction (0/10), Black participants with unmet preferences had COMM scores nearly twice as high as their white counterparts; by high satisfaction (10/10), this gap disappeared. In contrast, among control participants, the Black/white difference in COMM scores was small and relatively stable across all satisfaction levels.
What's next
The next step is to examine why some patients feel less satisfied with their pain care than do others. Future research will explore factors shaping patients' satisfaction with pain care and their impact on opioid misuse risk, such as shared decision-making and patient-provider trust.
From the experts
"While a great deal of studies on opioid misuse focus on overprescribing, this study flips the script by showing that under-prescribing—or more precisely, ignoring a patient's pain treatment preferences—can also lead to harmful outcomes, especially when patients are dissatisfied with their care," said Dr. Max Jordan Nguemeni, assistant professor-in-residence and the study's lead author. "It's one of the first to link racial disparities in pain treatment, patient satisfaction, and risk of opioid misuse in a single framework using longitudinal data."
About the study
Racial Disparities in Unmet Pain Treatment Preference, Pain Treatment Satisfaction and Subsequent Opioid Misuse: A Secondary Analysis of a National Multisite RCT . Published online June 25, 2025 by the Journal of General Internal Medicine. DOI: 10.1007/s11606-025-09637-w.
About the Research Team
Study co-authors are Dr. Eden Engel-Rebitzer of Brigham & Women's Hospital; Dr. Ari Friedman, Frances Shofer, Abby Dolan, Dr. Jeanmarie Perrone, Dr. Marilyn Schapira, and Dr. Zachary Meisel of the University of Pennsylvania, and Dr. Erik Hess of Vanderbilt University.
Funding and Disclosures
The Patient Centered Outcomes Research Institute (ID # CDR-1511–33496) funded the study.
