African-Americans Less Likely to Get ED Painkillers for Some Conditions

October 3rd, 2016

BOSTON – For certain “non-definitive” conditions, emergency clinicians are significantly less likely to prescribe opioids to African-American patients compared to white patients reporting the same pain levels.

That’s according to a new report, published by PLOS One.

The Boston University Henry M. Goldman School of Dental Medicine-led research discovered that black patients who visit EDs with back and abdominal pain are significantly less likely to receive painkiller prescriptions. Yet, that only occurred for conditions without clear clinical presentations and that are difficult to diagnose, study authors emphasize, and no differences were found for visits related to fractures, kidney stones, or toothaches.

Study authors suggest that pressure to be vigilant when prescribing opioids might increase the risk that physicians rely more on inappropriate subjective cues, such as race.

Researchers used the National Hospital Ambulatory Medical Care Survey (NHAMCS) to examine medications prescribed and administered in EDs during a five-year period from 2007 to 2011.

Results indicate that non-Hispanic black patients were less likely to receive opioid prescriptions at discharge during ED visits for back pain and abdominal pain but not for toothaches, fractures, and kidney stones, compared to non-Hispanic whites, with adjusted odds ratios that ranged from 0.56–0.67.

“Differential prescription of opioids by race-ethnicity could lead to widening of existing disparities in health, and may have implications for disproportionate burden of opioid abuse among whites,” study authors posit. “The findings have important implications for medical provider education to include sensitization exercises towards their inherent biases, to enable them to consciously avoid these biases from defining their practice behavior.”

"Access to healthcare and pain management decisions should be made without regards to patients' race-ethnicity,” added lead author Astha Singhal, DMD, PhD. “Healthcare providers need to be sensitized to their inherent biases, so that they can consciously avoid these biases from affecting their practice behavior.”