Provider and patient sex disparities in opioid prescribing and patient outcomes

Objective: To assess sex disparities in opioid prescribing practices and patient outcomes. Design: A retrospective cross-sectional study. Setting: Thirty-three primary care clinics in an academic health system. Participants: 2,738 adults prescribed 10+ outpatient opioid prescriptions within 12 months. Main outcome measure(s): Patient and primary care provider (PCP) sex-based differences in clinical outcomes, opioid prescribing, and rates of adherence to guideline-concordant opioid prescribing practices. Results: Female PCPs were more likely (p < 0.001) to prescribe lower morphine-equivalent daily dose (MEDD) of opioids and complete risk assessment for opioid misuse than male PCPs. PCPs did not differ by sex in adherence rates to controlled substance agreements, urine drug, depression screening, or opioid-benzodiazepine coprescribing. Female patients were more likely (all p ≤ 0.01) to be screened for opioid misuse, treated with lower MEDD, receive opioid-benzodiazepine coprescriptions, have higher pain interference, anxiety and depression diagnoses, and have an overdose diagnosis; they were less likely (all p < 0.001) to report alcohol use or have an alcohol use disorder diagnosis and utilized health care at higher rates than male patients. Conclusions: Sex differences were found in clinician opioid-prescribing practices and adherence to opioid prescribing guidelines and patient characteristics associated with long-term opioid therapy. Strategies to identify sex-related disparities and enhance guideline-concordant opioid prescribing and monitoring could contribute to improved patient care, and clinical and safety outcomes.