Poverty, Race Play Major Roles in Opioid Prescribing

Poverty, Race Play Major Roles in Opioid Prescribing

Black, Hispanic and poor patients in moderate to severe pain are less likely to receive opioid pain medications in emergency rooms across the U.S., according to a University of Rochester Medical Center study reported in the Journal of General Internal Medicine.

Racial and ethnic disparities in health care treatment have already been well-documented, but researchers believe this is one of the first studies to investigate whether poverty, income and education levels also influence the prescription of opioid pain medications.

512px-Health_professional_consults_with_patientInvestigators looked at a cross section of data from the National Hospital Ambulatory Care Survey from 2006 to 2009, which covered more than 50,000 visits at about 1,400 emergency departments at which opioids were prescribed. They used zip codes to identify socioeconomic status. Opioid medications tracked in the study include hydrocodone, oxycodone, morphine and codeine.

The researchers found that African Americans and Hispanics were less likely to get opioids for equivalent levels of pain. People who resided in poorer neighborhoods were also less likely to be treated with opioids than those from more affluent ones.

Patients in the highest income neighborhoods received prescriptions 49% of the time for moderate to severe pain, compared to 39% of the patients in lower income areas. Discrepancies also existed among various levels of poverty, with the poorest least likely to get opioids for pain.

Regional differences also were observed, with opioids prescribed more often in emergency rooms in the South and West, compared to the Northeast.

Although the study was not designed to answer why the disparities occur, the researchers say the results point to a need for more education for health care providers to promote unbiased prescribing.

“It is clear that disparities in the prescribing of opioids in emergency departments exist,” wrote lead author Michael Joynt, MD, of the Center for Primary Care, University of Rochester School of Medicine and Dentistry.

“It is imperative that national guidelines and safety standards be instituted in an effort to provide consistent and unbiased treatment for pain in all settings.  Policies such as uniform teaching to medical students and residents, specific guidelines and continuing education for current practicing providers, as well as accessible prescription monitoring programs, should be considered.”

Another study last year found that living in a poor neighborhood worsens the symptoms of chronic pain. Researchers at the University of Michigan Health System reported in The Journal of Pain that living in a lower socioeconomic neighborhood was linked with more pain, pain-related disability and mood disorders such as depression and anxiety. The study also found that blacks, especially young adults, had significantly more pain and disability whether they lived in lower or higher socioeconomic neighborhoods.

Ironically, the disparity in opioid prescribing between whites and African-Americans could be leading to more fatal overdoses among whites.

Poisoning deaths in the U.S. are now the leading cause of accidental death among white Americans, according to recent research published in the Journal of the American Medical Association. The rate of poisoning deaths among whites aged 20 to 54 was nearly twice that of blacks.

The exact causes of the poisoning deaths were not broken down in the study, although many experts believe it is being driven by a rise in the number of deaths caused by prescription opioid medications.

“I would imagine that this is disparity in health care is backfiring on the Caucasian population,” said Igor Galynker, a psychiatrist and associate chairman of the Department of Psychiatry at Beth Israel Medical Center told National Pain Report.

“White Americans have better access to health care and also probably have access to physicians that have more time for them, have more time to listen to their individual needs, and are more inclined to prescribe prescription painkillers and prescription opioids.”

Authored by: Pat Anson, Editor