Study: ER docs more likely to give narcotics to whites
CHICAGO (AP) - January 1, 2008 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.
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