Does Racism Influence How Doctors Prescribe Painkillers?
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Does Racism Influence How Doctors Prescribe Painkillers?

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New study says black patients are half as likely as whites to get painkillersAccording to an unsettling new study, African Americans are less than half as likely to be prescribed opioids in the emergency room than white patients. The findings, recently published in the journal Plos One, revealed that ER personnel would go out of their way to avoid prescribing painkillers to them. “A black patient with the same level of pain and everything else being accounted for was much less likely to receive an opioid prescription than a white patient with the same characteristics,” one of the study’s authors observed. It’s a curious observation—especially in the midst of an opioid epidemic that continues to ravage the country. The findings suggest that, while addiction doesn’t discriminate, medical professionals might.

What The Study Said

Researchers studied more than 60 million records of “pain-related emergency department visits from 2007 to 2011 for people aged 18 to 65”—a wide swath of people, to be sure. Experts then zeroed in on five specific conditions, which were then divided into two separate categories: “definitive” and “non-definitive.” Kidney stones and long-bone fractures fell into the “definitive” category, which just means they were easily diagnosed. Toothaches, abdominal pain and back pain fell into “non-definitive.” Oddly enough, when it came to non-definitive cases, black patients had “about half the odds” of being prescribed the same painkillers their white counterparts would receive.

Opioid addiction, largely fueled by prescription painkiller abuse, is a national health crisis. The CDC claims that the number of Americans who died of an opioid overdose has quadrupled since 1999. Not coincidentally, the agency says the number of prescription opioids quadrupled during that same time, too. From 2000 to 2014, nearly 500,000 Americans died from a drug overdose, which means nearly 80 die every day. The problem of “who gets prescribed what,” however, may have larger sociological and ethical implications than anyone’s actually considered. As the research points out: “We think this type of differential prescribing could be contributing to [the drug crisis].” If true, racial bias is one of the quietest factors in America’s drug epidemics. Sadly, it’s as easy to ignore as it is to explain away.

“This Isn’t Anything New”

The research doesn’t uncover anything new about how pain is managed. “This study unfortunately tells us what we already know—black patients are improperly treated for pain and that is mostly because of their skin color,” said Keisha Ray, a postdoctoral fellow in The Guardian piece. Ray contends the main problem is because black patients are treated as an “other.” If true, it could set treatment back even further in the face of our current epidemic. Earlier this year, a report published in The Washington Post claimed that “African Americans are routinely under-treated for their pain compared to whites.” The reason for different pain treatment? Medical providers still hold fast to false beliefs (shockingly so) when it comes to blacks. The list is long and disturbing. “Blacks age more slowly than whites.” “Blacks’ nerve endings are less sensitive than whites’.” “Black people’s blood coagulates more quickly than whites.” I felt like I was reading something from 1958—not a survey from 2016. These misconceptions are as insensitive as they are incorrect—putting many lives at risk in the process. Yet taken on a whole, these prejudices are accepted as truths among medical residents and attest to something much larger and disturbing about the state of the medical community.

Even worse, a similar study in PNAS came to the same conclusions about the roles racial bias plays in how pain was assessed and treated. The false understandings of the “biological differences between blacks and whites” bore the same findings. “A 2000 study out of Emory University found that at a hospital emergency department in Atlanta, 74 percent of white patients with bone fractures received painkillers compared with 50 percent of black patients,” the Washington Post story noted. “Similarly, a paper last year found that black children with appendicitis were less likely to receive pain medication than their white counterparts. And a 2007 study found that physicians were more likely to underestimate the pain of black patients compared with other patients.”

When it comes right down to it, the real problem lies in a much simpler place: “Black patients are not afforded the luxury of being seen in EDs, physician offices, and clinics as just patients in need of help and healing,” the new study’s author said. “Rather they are seen as less than human, drug seekers and overall exaggerators.”

What Needs to Change

The study makes a compelling, if not altogether depressing, argument that “because many clinicians assume black people are more likely to be addicts, they are less likely to receive pain medication.” The Guardian argues there’s a rich history of “assuming black people are more likely to be addicts, so even if they receive adequate pain treatment in the emergency room, they may not receive a prescription for it once they are discharged.” These are the sorts of quantifiable differences between whites and blacks that reveal much about racism in the medical community and its role in the opioid crisis.

Some experts argue that it’s a matter of certain cultures not being able to articulate their pain well enough. Christopher Ervin, advisor to the Black Women’s Health Imperative advocacy group, contended in The Guardian that they simply don’t have the adjectives available to them. “Many cultures may not be as demonstrative or vocal or assertive about pain and say: ‘Hey, I am hurting,’ particularly when, women in color in general, being vocal is not always to your benefit,” Ervin said. Adjectives aside, it might simply be not enough other blacks there to hear those concerns. We can’t overlook the lack of black physicians as part of the problem either, Ervin cautioned. “Only 4% of physicians are black, according to the Association of American Medical Colleges, and that number is not expected to improve,” the Guardian said. The association found that there were far fewer black men medical school in 2014 than in 1978. As much as anything, this is the true key. Even if more blacks don’t become physicians in the coming years, sensitivity training is paramount to getting pain management evenly distributed.

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About Author

Paul Fuhr is an addiction recovery writer whose work has appeared in The Literary Review, The Live Oak Review, The Sobriety Collective and InRecovery Magazine, among others. He is the author of the alcoholism memoir “Bottleneck.” He's also the creator and co-host of "Drop the Needle," a podcast about music and recovery. Fuhr lives in Columbus, Ohio with his family and their cats, Dr. No and Goldeneye.