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Blacks less likely to get painkillers
Drug Bias Seen In ERs Whites Likelier To Get Potent Painkillers
Combined Wire Services
January 2, 2008
Doctors are more likely to prescribe strong painkillers for white patients than for blacks and other minorities, according to a finding that researchers say may spotlight bias in the emergency room.
In the study, 37 percent of emergency room patients in pain got narcotics in 2005, compared with 23 percent in 1993, a change reflecting new methods to curb addiction and other side effects. At the same time, whites were about one-third more likely to get morphine or other opiate drugs than minorities.
Even for the severe pain of kidney stones, minorities were prescribed drugs such as oxycodone and morphine less frequently.
Some doctors fear patients will become addicted or will feign pain to get drugs, and minority patients in severe pain were most likely to be untreated as a result, researchers wrote in the Journal of the American Medical Association.
"This variability may partially result from racial/ethnic bias," said co-author Mark J. Pletcher, of the University of California, San Francisco.
The study examined 156,729 emergency room reports of patients in pain from 1993 to 2005. The analysis found differences in prescribing by race and ethnicity in both urban and rural hospitals, in all U.S. regions and for every type of pain.
"The gaps between whites and non-whites have not appeared to close at all," Pletcher said.
The increase in use of painkillers in emergency rooms over the 13-year period coincided with changing attitudes among doctors, who now regard pain management as a key to healing. Doctors in accredited hospitals must ask patients about pain, just as they monitor vital signs such as temperature and pulse.
Even with the increase, the racial gap has endured. Linda Simoni-Wastila of the University of Maryland, Baltimore, School of Pharmacy said the race gap finding may reveal some doctors' suspicions that minority patients could be drug abusers lying about pain to get narcotics.
The irony, she said, is that blacks are the least likely group to abuse prescription drugs. Hispanics are becoming as likely as whites to abuse prescription opioids and stimulants, according to her research. She was not involved in the current study.
The study's authors said doctors may be less likely to see signs of painkiller abuse in white patients, or they may be undertreating pain in minority patients.
Patient behavior may play a role, Pletcher said. Minority patients "may be less likely to keep complaining about their pain or feel they deserve good pain control," he said.
Stricter protocols for prescribing narcotics may help close the gap.
A New York hospital recently studied its emergency patients and found no racial disparity in narcotics prescribed for broken bones. Montefiore Medical Center aggressively treats pain and is developing protocols for painkillers that dictate initial dosages and times to check with patients to see if they need more pain medicine, said Dr. David Esses, emergency department associate director at Montefiore.
Such standards may eliminate racial disparities, Esses said.
In the study, opioid narcotics were prescribed in 31 percent of the pain-related visits involving whites, 28 percent for Asians, 24 percent for Hispanics and 23 percent for blacks.
Minorities were slightly more likely than whites to get aspirin, ibuprofen and similar drugs for pain.
In more than 2,000 visits for kidney stones, whites got narcotics 72 percent of the time, Hispanics 68 percent, Asians 67 percent and blacks 56 percent.
The data came from a well-regarded government survey that collects information on emergency room visits for four weeks each year from 500 U.S. hospitals. The new study was funded by federal grants.
"It's time to move past describing disparities and work on narrowing them," said Dr. Thomas L. Fisher, an emergency room doctor at the University of Chicago Medical Center who was not involved in the study.
Fisher, who is black, said he is not immune to letting subconscious assumptions inappropriately influence his work as a doctor. "If anybody argues they have no social biases that sway clinical practice, they have not been thoughtful about the issue or they're not being honest with themselves," he said.
Compiled from Associated Press and Bloomberg News reports
Combined Wire Services
January 2, 2008
Doctors are more likely to prescribe strong painkillers for white patients than for blacks and other minorities, according to a finding that researchers say may spotlight bias in the emergency room.
In the study, 37 percent of emergency room patients in pain got narcotics in 2005, compared with 23 percent in 1993, a change reflecting new methods to curb addiction and other side effects. At the same time, whites were about one-third more likely to get morphine or other opiate drugs than minorities.
Even for the severe pain of kidney stones, minorities were prescribed drugs such as oxycodone and morphine less frequently.
Some doctors fear patients will become addicted or will feign pain to get drugs, and minority patients in severe pain were most likely to be untreated as a result, researchers wrote in the Journal of the American Medical Association.
"This variability may partially result from racial/ethnic bias," said co-author Mark J. Pletcher, of the University of California, San Francisco.
The study examined 156,729 emergency room reports of patients in pain from 1993 to 2005. The analysis found differences in prescribing by race and ethnicity in both urban and rural hospitals, in all U.S. regions and for every type of pain.
"The gaps between whites and non-whites have not appeared to close at all," Pletcher said.
The increase in use of painkillers in emergency rooms over the 13-year period coincided with changing attitudes among doctors, who now regard pain management as a key to healing. Doctors in accredited hospitals must ask patients about pain, just as they monitor vital signs such as temperature and pulse.
Even with the increase, the racial gap has endured. Linda Simoni-Wastila of the University of Maryland, Baltimore, School of Pharmacy said the race gap finding may reveal some doctors' suspicions that minority patients could be drug abusers lying about pain to get narcotics.
The irony, she said, is that blacks are the least likely group to abuse prescription drugs. Hispanics are becoming as likely as whites to abuse prescription opioids and stimulants, according to her research. She was not involved in the current study.
The study's authors said doctors may be less likely to see signs of painkiller abuse in white patients, or they may be undertreating pain in minority patients.
Patient behavior may play a role, Pletcher said. Minority patients "may be less likely to keep complaining about their pain or feel they deserve good pain control," he said.
Stricter protocols for prescribing narcotics may help close the gap.
A New York hospital recently studied its emergency patients and found no racial disparity in narcotics prescribed for broken bones. Montefiore Medical Center aggressively treats pain and is developing protocols for painkillers that dictate initial dosages and times to check with patients to see if they need more pain medicine, said Dr. David Esses, emergency department associate director at Montefiore.
Such standards may eliminate racial disparities, Esses said.
In the study, opioid narcotics were prescribed in 31 percent of the pain-related visits involving whites, 28 percent for Asians, 24 percent for Hispanics and 23 percent for blacks.
Minorities were slightly more likely than whites to get aspirin, ibuprofen and similar drugs for pain.
In more than 2,000 visits for kidney stones, whites got narcotics 72 percent of the time, Hispanics 68 percent, Asians 67 percent and blacks 56 percent.
The data came from a well-regarded government survey that collects information on emergency room visits for four weeks each year from 500 U.S. hospitals. The new study was funded by federal grants.
"It's time to move past describing disparities and work on narrowing them," said Dr. Thomas L. Fisher, an emergency room doctor at the University of Chicago Medical Center who was not involved in the study.
Fisher, who is black, said he is not immune to letting subconscious assumptions inappropriately influence his work as a doctor. "If anybody argues they have no social biases that sway clinical practice, they have not been thoughtful about the issue or they're not being honest with themselves," he said.
Compiled from Associated Press and Bloomberg News reports
It cost a whole lot of $$ to feed that habit.
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