Prescribing gap may leave blacks in more pain
Study shows minorities are less likely to get narcotics from ER doctors
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 Dr. Mark Pletcher of the University of California,
San Francisco.
The study appears in Wednesday’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. 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 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.
Irony in race assumption
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.
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.
© 2008 The Associated Press. All rights reserved. This material may not
be published, broadcast, rewritten or redistributed.oh, and i want to add obese people to this list.Lori - I read that story this am and am not in the least bit surprised. My father always said the cheapest commodity on earth is a human, especially a brown one. That article shows his philosophy in action. It's inhumane and there is nothing that can be done. Guess it goes along the lines that it takes 9 years for a woman to be diagnosed with RA, and a man only one visit. That still blows me away. CathyHell... try being young, female and Hispanic!! (Sometimes it's a blessing in disguise though - pretending you don't know English.
Pip
P.S. Too funny Mel!
I read this earlier today and read it twice because I just couldn't believe what I was reading. Shameful.