African-Americans aren't prescribed opioids for pain at the same rate as their white peers, and they suffer more from their chronic conditions as a result, Abby Goodnough reports for the New York Times.
Research published Monday in PLOS One found that African-Americans are significantly less likely to receive opioids in the ED for abdominal or back pain. The study authors wrote, "Racial-ethnic minority patients, especially non-Hispanic blacks presenting with vague conditions often associated with drug-seeking behavior, may be more likely to be judged as 'a drug-seeker' relative to a non-Hispanic white patient, presenting with similar pain-related complain[ts]."
This aligns with a 2012 meta-analysis, which found African-Americans were 34 percent less likely than whites to receive opioids for common conditions such as migraines and backaches, and were 14 percent less likely to receive opioid pain relievers after traumatic injuries or surgeries.
Other experts concur. Raymond Tait, a researcher at St. Louis University, co-authored a 2004 study that found that workers' compensation programs spent less money and time treating African-American employees' lower back injuries, regardless of income level.
"Our data pretty clearly say it's a race issue," he said. "Our take on this was that during active treatment, we believe negative stereotypes impact clinical decision-making."
According to Adam Hirsh, a pain researcher at Indiana University-Purdue University, African-Americans are less likely than whites to misuse opioids because they're less likely to be prescribed opioids in the first place.
"We may agree that opioids can be harmful and that fewer of them may be a good thing," he said, "but we should not ignore that black and white patients are getting treated differently."
Consider Alabama, for example. According to CDC, it has the highest rate of opioid prescriptions in the country. However, according to Medicare data, almost every majority-African-American county in Alabama has an opioid prescription rate below the state average.
But while many researchers attribute this phenomenon to physician bias, others say it's due to socioeconomic factors, including Rita Evans, an African-American Alabama resident living in chronic pain due to spinal and nerve damage.
"I don't think it's prejudice," she told the New York Times. "I think it's the money." Evans is unemployed and does not have health insurance, and she said she is unable to afford opioid painkillers for her conditions.
According to Carmen Green, an anesthesiologist and professor at University of Michigan, both race and economics are factors. "The role of race is more important [in treatment disparities]," she said, "although race and class often intersect" (Goodnough, New York Times, 8/9; Singhal et al., PLOS One, 8/8).
How hospitals can reduce opioid prescriptions—and cut millions in costs
As legislators grapple with the opioid epidemic, hospitals are also rethinking their prescription practices. We polled over 200 acute care pharmacy leaders to understand how they are making formulary decisions, and what's the impact on reducing opioid prescriptions and related complications.
Read the research brief to learn more about our analysis of more than 400 organizations to investigate the impact of multi-modal pain regimens, and how your organization may be able to save over $1 million by reducing opioid use during surgery.