Findings show racial bias in emergency room prescriptions for non-definitive pain, as advocates say lack of diversity in medical field may exacerbate situation
Black patients are about half as likely to be prescribed opioid medicines in the emergency department than white patients, according to a new study.
The findings, published on Monday in Plos One, are the latest to show that minorities are treated differently when it comes to pain management.
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, said study co-author Astha Singhal, an assistant professor at Boston Universitys dental medicine school.
To determine whether there was a racial bias in pain medication prescriptions, the researchers looked at more than 60m records of pain-related emergency department visits from 2007 to 2011 for people aged 18 to 65.
Five conditions were examined and divided into two categories: definitive and non-definitive. The first referred to conditions that were easily diagnosed kidney stones and long-bone fractures and the second to conditions that are not: toothache, abdominal pain and back pain.
Black patients had about half the odds of being prescribed opioids compared to white patients for non-definitive conditions, according to the study, which Singhal co-authored with Renee Hsia of UC San Francisco and Yu-Yu Tien from the University of Iowa.
The findings may also point to a contributing factor to the opioid addiction crisis that claims 78 lives in the US a day and has primarily affected the white population, particularly people in rural areas and the north-east. We think this type of differential prescribing could be contributing to it [the crisis], said Singhal.
The study found no race-based differences for definitive conditions or toothaches, which Singhal said could be because emergency room doctors may be quicker to treat these conditions with medication because they are not dental experts.
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 with the McGovern Center for Ethics and Humanities at the University of Texas health science center at Houston.
She said the fundamental problem is that black patients are treated as an other.
This has been suggested for decades, but was starkly depicted in an April study about how disparities in pain management may be attributable to bias from medical providers who believe things such as that black people age more slowly than white people, and that black peoples blood coagulates more quickly than white peoples.
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, Ray said. Rather they are seen as less than human, drug seekers and overall exaggerators.
Ray and others said that because some clinicians assume black people are more likely to be addicts, they are less likely to receive pain medication.
Christopher Ervin, an advisor to the Black Womens Health Imperative advocacy group, said there is a 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.
Ervin said these study findings also show how differences in race can amplify the power discordance that exists between a patient and doctor.
For instance, a clinician may not recognize someones pain because of cultural differences in describing pain. 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.
And the dearth of black physicians exacerbates the situation. Only 4% of physicians are black, according to the Association of American Medical Colleges, and that number is not expected to improve: the association also found that in 2014 fewer black men were in medical school than in 1978.
Ervin and the study authors said their findings show the benefits of incorporating sensitivity in medical training to show providers their inherent biases.
If you dont have that culture of diversity in your training and in your development, when will you get it? Ervin said. Until someone sues you.