New Study Reveals: Minorities Less Likely to Receive Narcotics for Pain in the ER

A few of you wrote me about the results of this study funded by the U.S. Department of Health and Human Services on the disparity in the pain management in the ER based on ethnicity. It's appalling.

The study, which analyzed treatments for more than 150,000 pain-related visits to U.S. hospitals between 1993 and 2005, found 23 percent of blacks and 24 percent of Hispanics received opioids compared with 31 percent of whites. Twenty-eight percent of Asians and other groups received opioids.

- Differences in prescribing between whites and non-whites were greater among people with the worst pain. Among patients in severe pain, opioids were prescribed to 52 percent of whites, 42 percent of Hispanics and 39 percent of blacks.

- Blacks were prescribed opioids at lower rates than other groups for almost every type of pain-related emergency department visit, including back pain (33 percent for blacks versus 48 percent for whites), headache (22 percent versus 35 percent) and abdominal pain (20 percent versus 32 percent).

- Opioids were prescribed less often for blacks than whites for kidney stones (56 percent to 72 percent) and long bone fractures (45 percent to 52 percent).

- Non-opioid pain relievers, such as acetaminophen (sold as Tylenol), were prescribed more for non-whites (36 percent) than whites (26 percent).

This study is particularly timely since I've 1) been to the ER recently and 2) had gall bladder surgery last week. Both resulted in my receiving morphine while inpatient and pain-relieving opioid drugs for use at home. While I can't say that I experienced biased care and withholding of these medications because of my race, I have no doubt that implicit bias plays a role in denial of adequate medical pain management in many cases. I was simply fortunate.

I highly recommend Blender JulieWaters' diary on this, Medical care and racism: this is your war on drugs, which I noticed while working on this post. It gets to the heart of the third rail discussions that you all simply love to comment about -- not.

This is about having a discussion about the spectrum of racism and bias, not accusing people of running around in a Klan Night Rider hood. People often head straight for the defensive zone there to make sure everyone knows they aren't "racist," when in fact this study proves that implicit bias has direct impact on minority health and well being. It's there, and it's dangerous.

When talking about racism, it's easy to reduce it to the simplistic: to assume that everyone's racist to some degree and that while whites can act racist towards blacks, sometimes blacks are racist against whites as well. So let's get that out of the way first, by distinguishing between "small r" racism, which is personal racism: "I don't think I'd ever want to date a black man." "I lock my doors in that neighborhood." While problematic, occasional personal individual racism is not nearly as damaging as large-scale ("big R") institutional Racism, which is just intensely dangerous and is implemented nearly universally to the detriment of non-whites.

And it's not a matter of whites shouldering all the blame for holding those biases. See after the jump.