Pain Medicine: Emergency Room Doctors More Likely to Prescribe Opioids to Whites Than Minorities
A new study has found that while emergency room prescribing of opioid pain medications for ER patients complaining of pain has increased in recent years, doctors are less likely to prescribe them for minority patients than white ones. Even in cases where patients complain of severe pain, such as kidney stones, the difference holds.
The study, "Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments," was published this week in the Journal of the American Medical Association. It analyzed more than 150,000 ER visits between 1993 and 2005 and found racial differences in prescribing in all US regions, in both urban and rural hospitals, and for all types of pain.
The study found that the prescribing of drugs for pain in the ER rose during the period in question, from 23% of those complaining of pain in 1993 to 37% in 2005. That increase reflects increased understanding of the necessity of pain management by physicians. Now, doctors in accredited hospitals must ask patients about pain, just as they monitor vital signs. But while prescribing is on the increase, the racial divide remains.
According to the study, 31% of white patients in pain were prescribed opioids, compared to 28% of Asians, 24% of Hispanics, and 23% of blacks. When it comes to the severe pain related to kidney stones, whites got opioids 72% of the time, compared to 68% for Hispanics, 67% for Asians, and only 56% for blacks.
"The gaps between whites and nonwhites have not appeared to close at all," said study coauthor Dr. Mark Pletcher of the University of California, San Francisco.
Researchers are looking for reasons for the discrepancy. Pletcher suggested to the Associated Press that minority patients "may be less likely to keep complaining about their pain or feel they deserve good pain control."
Linda Simoni-Wastila of the University of Maryland, Baltimore, School of Pharmacy told the AP the findings could reveal some doctors' suspicions that minority patients could be drug abusers lying about pain to get narcotics. She said that according to her own research, blacks are the least likely group to abuse prescription drugs.
The study's authors suggested that the finding could indicate either that doctors are less likely to see signs of pain reliever abuse in white patients or that they are underrating pain in minority patients. Whatever the reason, it seems that the racial injustice associated with drug prohibition reaches even into the emergency room.
"It's time to move past describing disparities and work on narrowing them," Dr. Thomas Fisher, an emergency room doctor at the University of Chicago Medical Center who was not involved in the study, told the AP. Fisher, who is black, said that even he needed to be careful not to let subconscious assumptions inappropriately influence his prescribing decisions. "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.
Comments
This has been going on for years!
As a pain doctor, I noticed that an attitude amoungst many physicians, including those of color, was that the races that got less pain medication deserved them less. There is also a discrimnation against women, as compared to men. Until the crazy attitude, that the DEA knows better than doctors, how to treat the patients' pain, ends, the people will be the real losers. They are placed into a type of chronic torture after already having the bad luck to suffer form chronic intractable pain. Blacks were seen as "lazy" and Mexicans were just "over-emotional". Women were "hysterical"! (term related to uterus) Sad thing is, not only are pain patients treated this way, but so are many other medical patients. Their complaints go ignored and unheard, by doctors "too busy" to listen!.
A close relative has been cut off of her pain medicine by her family doctor. While, at the same time, another doctor (surgeon) has come up with the fact that has had wide-spread cancer! Oh, but the family doctor knows better. He has all of her records documenting the possible presence of this cancer. He told her the spot on her X-ray "was nothing"! And, he still harasses her about taking her pain medication, which she does properly as prescribed! I guess that bone pain from the cancer does not deserve treatment because she is just another "hysterical" woman!
When are doctors going to stop acting like cops and treat the patients! They don't listen any more. (They over-delegate those resposibilities to subordinates) And when are cops going to stop thinking that "all pain doctors are just drug pushers"! They, at the same time, say all people, that have to take opiates, on a daily basis, for pain control, are "addicts"?
The DEA, drug task force, or any other cops have no business in any doctor's pratice, if they can't get it right, in the first place!! What the heck ever happened to physician/patient relationship (and/or) doctor/patient confidentiality? The drug war is truely a war against the American people! Time for the cops to suffer for their abusive actions, and not the patients!
In reply to This has been going on for years! by mlang52 (not verified)
Where are you Located?
Hi I was wondering where you are located? I am a 33 year old mother of 2 and I have chronic lower back pain. My doctor tells me that it is because I am to skinny and there is nothing that he will do for it. I have told him on many occasions that Arthritis in the back runs in my family on my fathers side. He told me that I am to young for this to happen to me. I again went last week because the pains is so bad, and when I wake up in the morning it takes me forever to get out of bed. I am so stiff I actually have to crack my back to straighten out. My tail bone on the bottom of my back seems to be in the shape of a Y and that is where alot of the pain seems to be coming from. He again told me that it was because I am to skinny. Yes I am a small framed woman but I should not have to suffer because of it. I try and go shopping with my children and I cant even walk through the store without my back and legs killing me! What do you suggest that I do?
In reply to Where are you Located? by Jaime (not verified)
back pain
Hi,
I suffer from debilitating back pain, and have for about 8 years. My Dr.. had me on morphine, (which is weird because morphine doesn't help back pain.) Anyway I took it for about six years. I couldn't take any more. I was going crazy. I finally went to a spine center. They deal with mostly spine issues. I was to the point I couldn't' bend to wash my kids hair in the tub. I had more injections then I care to think about. They didn't work, except the coccyx injection, it hurt but was so worth it after. They finally went in and clipped the nerves in the lower part of my back. I am pain free still, and it's been six months. They say it can last for some people years, I hope it helps. I have to take no pain meds at all, and I can get out of bed in the morning and it doesn't take 20 minutes.
In reply to This has been going on for years! by mlang52 (not verified)
Pain
It is truly over whelming with what has been taking place over the last couple of years. I have been in pain (off and on) since I was 11 years old and I am now 40. I have been under medicated and over medicated. Of course now I am being under medicated - again.
Certainly there Is a problem. However, the "powers that be", imho, are going about things wrong - for a lack of more time and energy.
All I want is to live my life. I have lost so much already. Now I am on the verge of having my business plan funded by a venture capitalist who knows an old friend. Any one who owns a business or who has ever tried to get VC funding knows what a feat it is to obtain such funding.
Yet, here I am - with a quarter the medication I need in order to enjoy my life and in Full Fear that if I do not find a doctor who will be willing to give me the amount of medication I need to function - I will Fail in my life once again. And so many people, that are depending upon me will lose out.
I am so tired of being punished because of what someone chooses to do with their freedom!! And all I want is a chance to have a life.
This topic blows my mind. I cannot even begin to fully grasp my anger. As I sit here my pain has been out of control for hours but I cannot take an other pill for nearly two more hours. Why must I suffer like this when the medication I need is available? I am tired of being angry, sad, depressed, grumpy and so forth all because I need more life giving medication that our society feels ought to be afforded to me. : ( ::::::::::::
The whole situation is just beyond words for me.
In reply to This has been going on for years! by mlang52 (not verified)
reply to subject of pain control
Dear Doctor,
I have just read your article on pain control and its related issues of the DEA having their way LIKE BURGER KING.
I have 8 herniated discs, spinal stenosis, scoliosis, degenerative disc disease and various other pain in my knees, hips, etc. Needless to say, I am in excruciating pain most of the time. I get chewed out by every doctor that walks the earth, and yes they label one an addict. If these doctors and the dea only knew what it is like to live in constant torment, they would say no more. It did my heart some good to see some compassion for a change in your letter. I can only hope that things will change for those of us that really suffer and just want quality of life, without struggling to get up and walk. It is a fight to survive.
Thanks again for the only thoughtful and concerned letter I have seen to date.
Gratefully,
Barbara
Bias against women
If you are female and need to be treated in the ER it is always better if you have a man with you. I know this from personal experience. And many women who participate in online pain forums agree.
It's not right. It's just how it is.
I have never understood why doctors do not believe us when we say that we are in pain. I remember that one doctor told me that since I "could walk and talk" that I couldn't be in that much pain.
My pain control finally came a few years ago, but that was after decades wasted in hell.
Ruthanne
In reply to Bias against women by Anonymous (not verified)
you are so right!
I suffered from endometriosis for 29 yrs.
I would go to the ER with my boyfriend and the doctor would talk to him about my period! - ?? Yup!
Well, when did her pain start? How bad does it really seem? As if I were Not even in the room! Or the patient for that matter!
I would Never got to the ER w/out a man unless I had no choice at all. Great advice. as sad as it is
Some people
It's amazing how a person with no basic intelligence or imagination will resort to childish" humor" in an effort to???As a person that's been on a waiting list for proper pain control forever,I can tell you it's no joke.Then again,neither were any of C's comments.
In reply to Some people by Anonymous (not verified)
FYI
FYI, I deleted the meaningless comments to which this comment was responding. It was not a response to any of the comments appearing above now.
David Borden, Executive Director
StoptheDrugWar.org: the Drug Reform Coordination Network
Washington, DC
http://stopthedrugwar.org
chronic pain for 13 yearsI have suffered
I have suffered from chronic pain for 13 yrs and still do not get the dosage I need to come close to giving me enough pain relief to enjoy life. I am in so much pain at night I can't sleep more than 2 to 3 hours at a time. I am writing this at 5:30 am & have beeen up since 4am due to pain and have an appointment at 10:30 that I hope I can make it to with out falling asleep at the wheel. I have been trying to get my doc to believe me for years. You are right about taking your husband along, I did get the MRI I had requested 2 times before. I have raised 4 kids & have a degree in social services, I am an adult I don't lie about pain. I had all 4 with out meds, I can tolerate pain for a while but 13 years is too long.
Pain Meds
What I've noticed is doctors will give pain meds out to women like candy, but for men they suggest Tylenol or some other over the counter cure. If you do get pain meds for the exact same symptoms, they would give the guy Vicodin while giving the girl Percocet. For example: there's a better than average chance I have a slipped disc in ym back right now. I can't afford the visit to the orthopedic surgeon, so I have to rely on either the ER or clinic if it gets too bad. Their suggestion? A warm bath and some Alleve. Umm, been there, tried that, doesn't come close to helping. If you tell them the only thing that works is a 5th of Jim Bean they look at you like you're looking to get high when the reality is since you aren't using anything illegal and trying to manage the pain via the doctor and not being helped, drinking till the pain goes away or you pass out is a logical solution. I don't get it. I had a wisdom tooth out years ago and the dentist gave me a bottle full of Percocets, but back pain doesn't qualify as being as severe? Really? And they wonder why people turn to street drugs. It's because the are in pain and no one will help them. Why doctors even have the ability to prescribe pain medication is beyond me since they don't seem to like to.
Pain Meds
I am glad to know I'm not the only one who has an ongoing battle with doctors to get prescribed something to be able to function and live a productive life. It wasn't until recently (after 14 years) that I was diagnosed with lower lumbar facet arthritis. Go ahead and look up what tge symptoms are, basically I have lower back pain and widespread pain due to bone spurs on my lumbar that also inflames my nerves and causes a "binding" and "pulsing" pain from my buttocks and my thigh at the same time as my lower back hurting.. But for years I was told to take motrin and a heating pad.. And for years I was "tooyoung" I'm 35 now... But at what point do they actually start to listen aboutpain.. Just because I'm under 50 I guess I really don't have joint pain or arthritis, or tendinitis... In justfaking it to get pain meds... Like I really want to go through countless of hours and dozens of doctor visits because I'm addicted to pills.... I'd I really was I'd just buy them off the street. I can't wait to see our Heath care system fail so we can have a gov. Run system like most countries where the doctors don't have an agenda but to treat patients!! God bless America
How African American are View vs.Whites when req. Pain Rx
I had this constant pain in my groin area on/off for three years. It now very constant pain especially when I walk it has really become unbearable for me. Went to one Dr. who told me I would have to learn to live with this pain that 3 years ago. Well the pain is back and has not gone away or subsided with soaks, hot/cold treatment, otc Rx. nothing has help. This pain is so bad I can hardly walk well, went to the Dr. today
who did not examine me just asked questions, requested something for pain her advise was to keep soaking and take Advil/Aleve/ or Tylenol. No empathy no pleasent bed side manners, nothing. This how the majority of African Americans are treated when they request any pain medications. Doctors treat us as tho we are addicts w/o getting to the gist of ailments. Educated fools from Uneducated schools.
pain beyond our chronic pain
I just wanted to add that beyond the chronic pain from the multiple genetic causes of my pain for which I am once again being under medicated - I recently developed an infection in my right foot called Cellulitis. I believe that is how it is spelled.
Any way, I would honestly prefer to have a few kidney stones, a third degree burn and all of my painful conditions flared up at the exact same time than to be dealing with this gosh awful Cellulitis! But do you think for one moment my "doctor" (yes i use the term doctor loosely), would allow me to take any "extra" medication for the pain above and beyond my usual pain? No, of course he would not. So, I have now lost three weeks of working on my business plan. Not that he cares - of course.
I had surgery this past June. My surgeon is a narcotic Nazi! (sorry to use that word but it fits). He was the Only one I could find to do the surgery I have waited most of my life to have done.
Thank God above! The anesthesiologist who came to put me under for my surgery was my pain management doctor from way back when I was still a 'kid'.
He went up one side of my surgeon and down the other! My surgeon told me Not to wear my pain patch during surgery. He also planned on sending me home the same day to take my usual pain meds! My "old" doctor made it so I could put my patch back on and so I could take my break through medication before surgery began. He also made it so I could stay one night with an IV of pain medication!! I do not know what I would have done without having him come to my rescue! My post op pain was so severe I wanted to die. My "old" doc told my surgeon that he knew Nothing about pain management and that he was disgusted with his lack of compassion. I wish I could tell you everything. I mean he really stood up for me. I wish I could have had it on video to watch over and over!
Sadly, because of the way things are these days he no longer treats chronic pain patients!! : ( How awful is that a decent, compassionate human being has been forced out of helping countless people that suffer from chronic pain?? Sorry, just had to share this with you.
A Few Stories from a True Chronic Pain Sufferer & Patriot n Fear
A Few Stories from a True Chronic Pain Sufferer & Patriot n Fear
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