Rx Gap In ER May Leave Minorities In Pain

Study: Whites More Likely Than Minorities To Get Strong Narcotics From ER Doctors

(AP)  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 and ethnicity 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.

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.

Stricter protocols for prescribing narcotics may help close the gap.

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.

[payasyougo]

Study: Whites More Likely Than Minorities To Get Strong Narcotics From ER Doctors

Oh, then that would explain how ERs attract white people.

[rohink-2009]

ROHINK, Sounds like your pi$$ed at white folks! What no c*r*a*c*k at your last ER visit?

Posted by roadking041

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I''m not angry at white people, just pissed off with stupid stories like this. It was sarcasm...........

[mkbjon]

''''Sensational'''' stories of this type are counter-productive and only serve to magnify pointless hatred.
Posted by Toolmangler

That''s not completely true. I am black, and this article does not make me hate any ethnic group more because I know better than to stereotype. Trust me, if people want to hate another group, they will FIND a reason or excuse with or without your assistance. I do think this is a relevant topic because I was certainly not aware of it, and I''ll wager that some of the doctors who read the article are not aware of it either. By bringing the discussion to the forefront instead of sweeping it under the rug, there is at least the possibility of effecting some improvement in the situation.

[toolmangler-2009]

Why is this story here? what good does it do. Other than to start a racist fired controversy and to inspire radical nutjobs to commit ''get-even'' crimes it does no good. give this story to the health care providers and tell them to fix it or face huge fines. ''Sensational'' stories of this type are counter-productive and only serve to magnify pointless hatred.
Don''t hide the error, make it right, Blacks, Browns and Yellow peoples shouldn''t hurt any more than their White Planet sharers (fellow Humans)Before they are helped.
sssshhheeeeeeesssshhhh!!!!!!!

[antoniof123]

So what I try not to take drugs and if white people (I am white) want to kill themselves let them I don''t care. I sound like a compassionate conservative, I had better rethink my position.

If you want to kill yourself then it should be OK just clean up the mess.

[joeymed2009]

the problem with the healthcare system is created by stupid people.... if we educate people and tell them to quit smoking, quit eating, quit getting fat, quit doing drugs, quit causing harm to yourself.....then people would not go to the hospital 1/10 as much as they do....but people in this country are stupid.. education is the key

[scully152]

I would be more interested to see not the disparity in how narcotic are prescribed for pain in the ER in regards to race but would rather see who has their own health insurance and who has State sponsored health insurance. A good majority of whites received prescriptions for narcotics but not all. I bet those one who did NOT receive it have the state sponsored health insurance.

[krotec54]

So what.
Who pays for the medication? And who don''t pay?

[runningralph]

It may be bias or prejudice. It could also be experience. Some say experience is the best teacher.

[pete_in_az]

I think many more patients could have Oxycodone available to them, but Rush Limbaugh is taking more than his share first.
Posted by exCoachKen at 05:35 PM : Jan 01, 2008
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Yeah well even though you are joking you really are on to something here. Way too many people are going to the ER to get high these days. Here in Arizona, where in many cities like Tucson, whites are the minority population yet the ER is clogged full of people who demand certain drugs. These are the same people who know all the right things to say during the admit process to move to the head of the line (fake chest pain, etc). All the while people (of all races equally) are literally dying to get treated. Thats the answer to the disparity this worthless study and article fail to address.

[rowdytexan2]

Gawd, remind me not to go to Rush''s hospital~~~~

[excoachken]

I think many more patients could have Oxycodone available to them, but Rush Limbaugh is taking more than his share first.