Prescribing gap may leave blacks in pain

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.