White people who visit hospital emergency rooms with pain are 26% more likely than black people to take opioid painkillers such as morphine.This is an important discovery our latest research,Published on Journal of General Internal Medicine. We also found that black patients were 25% more likely than white patients to take only non-opioid pain relievers like ibuprofen, which are often available over the counter.
We examined more than 200,000 patient visit records for pain treatment, drawn from a representative sample of U.S. emergency departments from 1999 to 2020. Although white patients were more likely to receive opioids for pain, we found no significant differences by race in the type or severity of patient pain. Furthermore, racial disparities in pain medications persisted even when we adjusted for differences in insurance status, patient age, census region, or other potentially important factors.
Our analysis of prescribing trends recorded over two decades found increases and decreases in opioid prescribing rates, reflecting changing attitudes toward opioid use in clinical practice. Notably, however, prescribing differences by race appear to have changed little over time.
why this is important
These findings are important because they illustrate efforts over the past two decades to promote equitable health care in the United States, e.g. Affordable Care ActOr “Obamacare” doesn’t seem to have translated into clinical practice yet—at least when it comes to pain management in hospital emergency rooms.
There is no doubt that as The ongoing opioid crisis Continuous upgrade, a careful balance must be struck between the risks and benefits of prescription opioids. But their proper use is an important part of ED pain control, and they often provide better relief than non-opioid medications for short-term moderate to severe pain.
Under-treatment of pain creates unnecessary suffering and can lead to a range of negative outcomes, including Long-term pain is more likely to occur.There are more than There are 40 million pain-related emergency department visits each yearit is therefore clear that equitable pain care is a fundamental component of an equitable health care system.
Don’t know what yet
We don’t know why there are such stark racial differences.some researchers argued Reducing opioid prescribing may benefit Black patients because it may reduce the risk of addiction.But that argument doesn’t square with data, which shows drug overdose rates have traditionally been The black population is smaller compared to the white population.However, this trend has Beginning to change in recent years.
Additionally, some evidence suggests that clinicians Unconscious bias may existmistakenly believing that black patients are less sensitive to pain or that certain racial groups are less sensitive to pain Reluctant to accept painkillers.
Although there is preliminary evidence that these factors may be important, there are insufficient studies to examine the extent to which they impact clinical practice. Researchers like us also know little about whether promising remediation strategies based on these factors—such as educational training to challenge stereotypes during medical school—are effective in the real world or even implemented.
What’s next?
The need to address racial disparities in health came into focus again in February 2023, when Biden-Harris Administration Signed executive orders furthering racial equity. Given the long history of these problems, it is clear that more research is needed to help develop better strategies to address health inequalities.
The most effective strategies to address racial disparities in pain treatment may be those that target underlying causes. We are currently conducting research to try to better understand these causes, how they contribute to differences in real-world clinical practice, and whether strategies designed to address them are actually effective.
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