People who are poor, African American or both are less likely to be prescribed opioids for pain than well-off white patients, according to a new study. The powerful painkillers, which include codeine and oxycodone, have been in the spotlight recently as deaths from overdoses rise and more drugs end up in the hands of people taking them for non-medical purposes.
Past studies have found that blacks in pain don't receive opioids as often as whites, but the new study suggests economic differences matter in addition to racial ones. "The disparities are concerning and definitely warrant further investigation," said Dr Michael Joynt, who led the study at the University of Rochester School of Medicine and Dentistry in New York. However, he added, there's probably not "any one single factor" that explains those disparities.
One researcher not involved in the study said cultural differences between doctors and patients and a lack of time to closely evaluate each person in the emergency room may encourage unconscious stereotypes that affect doctors' treatment decisions. Lack of standardised guidelines on how to treat pain may also be a factor, Joynt told Reuters Health.
He and his colleagues analyzed data from about 1 400 hospital ERs between 2006 and 2009. During that span, the ERs prescribed opioids to just over 50 000 people reporting moderate or severe pain. Both race and income were linked to a pain patient's chance of being prescribed an opioid. For example, 46% of white patients with moderate or severe pain were given opioids, compared to 39% of black patients. And 45% of non-Hispanic people received the drugs, versus 40% of Hispanics. Likewise, 47% of pain patients from the wealthiest neighbourhoods, based on zip code, were prescribed opioids, compared to 41% from the poorest areas, the study team reports in the Journal of General Internal Medicine.
The disparities held after the researchers took into account patients' injuries and the severity of their pain. Michelle van Ryn said very few doctors have overt negative attitudes toward minorities or poor people, and all strive to provide equal care. Prescribing disparities are not about "a conscious, intentional process of harm", van Ryn, from the Mayo Clinic in Rochester, Minnesota, told Reuters Health. "It's that there are factors that prevent clinicians from behaving in ways that are consistent with their best intentions and goals," she added.
That can include busy, crowded ERs and misunderstandings between patients and doctors from different cultural backgrounds, said van Ryn, who has also studied racial disparities in opioid prescribing. The researchers said they hope their study will spark a conversation about pain control and differences in care on a societal scale. But patients can initiate those talks in the ER too, they said.
"I think it's important for patients presenting for pain to have an open and honest discussion with their providers," said Dr Robert Fortuna, who also worked on the study."The issue of gauging pain is very nuanced."