Racial Divide Found in Painkiller Study

Emergency room doctors are prescribing strong narcotics more often to patients who complain of pain, but minorities are less likely to get them than whites, a new study finds.

Even for the severe pain of kidney stones, minorities were prescribed narcotics such as oxycodone and morphine less frequently than whites.

The analysis of more than 150,000 emergency room visits over 13 years found differences in prescribing by race in both urban and rural hospitals, in all U.S. regions and for every type of pain.

“The gaps between whites and nonwhites have not appeared to close at all,” said study co-author Mark Pletcher, of the University of California, San Francisco.

The study appears in today’s Journal of the American Medical Association. Prescribing narcotics for pain in emergency rooms rose during the study, from 23 percent of those complaining of pain in 1993 to 37 percent in 2005.

The increase coincided with changing attitudes among doctors, who now regard pain management as a key to healing..

Linda Simoni-Wastila, of the University of Maryland, Baltimore, School of Pharmacy said the finding might reveal some doctors’ suspicions that minority patients could be drug abusers who are lying.

The irony, she said, is that blacks are the least likely to abuse prescription drugs. Hispanics are becoming as likely as whites to abuse them, according to her research. She wasn’t involved in the current study.

The study authors said doctors might be less likely to see signs of painkiller abuse in whites, or they might be undertreating pain in minorities.

Patient behavior might play a role, Dr. Pletcher said. Minority patients “may be less likely to keep complaining about their pain or feel they deserve good pain control,” he said.

In the new 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.

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 data on emergency room visits for four weeks each year from 500 hospitals.

“It’s time to move past describing disparities and work on narrowing them,” said Thomas L. Fisher, an emergency room doctor at the University of Chicago Medical Center.

Dr. Fisher, who is black, said he isn’t immune to letting subconscious assumptions inappropriately influence him. “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.”

Originally published by Carla K. Johnson Associated Press.

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