RACIAL DISPARITY IN OPIOID PRESCRIBING
- September 14, 2018
More than 40 percent of opioid overdose deaths in the United States are attributed to prescription opioid painkillers. One of the ongoing efforts to combat the opioid crisis involves working with doctors to end the overprescribing of these drugs, including giving people fewer pills at a time and recommending alternative medications or therapies. However, there hasn’t been a lot of research done on the way opioid use is monitored when it is prescribed. Recently, researchers from Yale University discovered that there is a racial disparity when it comes to both monitoring and treatment of patients taking opioid medications.
The Yale researchers were supported by grants from the National Institute on Drug Abuse, National Center for Advancing Translational Sciences, and the National Institute on Alcohol Abuse and Alcoholism. They analyzed data from the health records of more than 15,000 patients who received opioid painkillers from the Veterans Administration between 2000 and 2010. They were examining whether patients were screened for illicit drug use after starting opioids, which is a process recommended by the Centers for Disease Control and Prevention. They also looked into whether, when people tested positive for either marijuana or cocaine, doctors discontinued the use of those opioids.
They found that not many patients were tested for illicit drug use at all, but black individuals were more than twice as likely to be screened. When patients did test positive for marijuana or cocaine use, 90 percent were allowed to stay on their opioid regimen, but black patients were twice as likely to have opioids discontinued if they tested positive for marijuana and three times more likely if they tested positive for cocaine.
Researchers say that this is part of a larger problem in how healthcare varies between black and white patients. There are no actual rules in place regarding whether or not to discontinue opioid use if someone tests positive for other drugs, so doctors find it left to their own discretion. Unfortunately, according to the Yale team, what this means in practice is that many doctors end up falling back on racial stereotyping.
White people are actually at the highest risk for opioid overdose and death. Part of the reason for this goes back to stereotyping, because doctors have historically been less likely to prescribe opioids for minorities, perhaps believing that they were at higher risk for abusing or selling them. Most of the opioid overdose deaths among blacks are as a result of heroin, fentanyl, and other synthetic opioids. (Cocaine is actually the highest contributor.) Still, opioid overdoses in general are on the rise among minorities, particularly black and Hispanic Americans.
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