Minorities less likely to receive pain-relieving opioid drugs in ER

Jan 7 2008

Blacks and Hispanics who go to hospital emergency departments in pain are significantly less likely than whites to get pain-relieving opioid drugs, according to a new study funded by the U.S. Department of Health and Human Services.

The study, which analyzed treatments for more than 150,000 pain-related visits to U.S. hospitals between 1993 and 2005, found 23 percent of blacks and 24 percent of Hispanics received opioids compared with 31 percent of whites. Twenty-eight percent of Asians and other groups received opioids.

“This study provides a particularly compelling reminder that treatment disparities persist among racial and ethnic groups,'' said Carolyn M. Clancy, M.D., director of the HHS Agency for Healthcare Research and Quality. “We have a lot of work to do before high-quality health care is available to everyone.”

The study, “Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments,” was published in the January 2 issue of JAMA. The research was funded by AHRQ and the National Institute on Drug Abuse, part of the National Institutes of Health.

“Minority health disparities are an urgent problem in this country,” noted Nora Volkow, M.D., director of the NIDA, “and should be addressed through efforts to educate physicians, reduce stigma and promote cultural competence across all health care settings.”

Opioids are narcotic pain medications used to treat patients with moderate to severe pain. The new study analyzed the use of several commonly prescribed opioids, including hydrocodone, meperidine, morphine, codeine and oxycodone.

Among patients in pain in emergency departments, the use of opioids increased from 23 percent in 1993 to 37 percent in 2005. That trend accelerated in 2001 when The Joint Commission, which accredits health care organizations, and the U.S. Department of Veterans Affairs initiated campaigns to improve the quality of pain control in hospitals. The new study is the first to measure opioid prescribing trends since those efforts.

The study is based on data compiled by the National Hospital Ambulatory Medical Care Survey, which is administered by the U.S. Census Bureau. Study authors, led by University of California-San Francisco researcher Mark J. Pletcher, M.D., M.P.H., analyzed 374,891 emergency department visits over 13 years. Of those visits, 156,729, or 42 percent, were related to pain.

Among the study findings:

• While the use of opioids increased overall between 1993 and 2005, the differences in use between racial and ethnic groups did not diminish. In 2005, the last year of the survey, 40 percent of whites in pain received opioids; 32 percent of all others received the drugs.
• Differences in prescribing between whites and non-whites were greater among people with the worst pain. Among patients in severe pain, opioids were prescribed to 52 percent of whites, 42 percent of Hispanics and 39 percent of blacks.
• Blacks were prescribed opioids at lower rates than other groups for almost every type of pain-related emergency department visit, including back pain (33 percent for blacks versus 48 percent for whites), headache (22 percent versus 35 percent) and abdominal pain (20 percent versus 32 percent).
• Opioids were prescribed less often for blacks than whites for kidney stones (56 percent to 72 percent) and long bone fractures (45 percent to 52 percent).
• Non-opioid pain relievers, such as acetaminophen (sold as Tylenol), were prescribed more for non-whites (36 percent) than whites (26 percent).
• Opioid prescribing rates were particularly low for black and Hispanic children; blacks in government-owned, non-federal hospitals; uninsured patients; and among all non-white patients in hospitals in the Northeast.

The study did not conclude why non-whites were less likely to receive opioids, but suggested racial and/or ethnic bias as a significant factor.

“Causes of disparities in medical care, however, are complex, and simple racial/ethnic bias is unlikely to fully explain the problem,” the study noted. Race and ethnicity influence all aspects of the relationship between patients and clinicians, including how patients communicate pain to doctors, what kinds of treatment are requested and how medicals staffs respond, the study said. Authors said that new strategies are needed to address pain management in emergency departments, perhaps including changes to pain treatment regimens or educating patients to specifically ask for pain relief.