Study Shows Possible Bias in Emergency Room Care
Virginian - Pilot
1-2-2008
From wire reports

Doctors are more likely to prescribe strong painkillers for white patients than for blacks and other minorities, according to a finding that researchers say might spotlight bias in the emergency room. In the study, 37% of emergency room patients in pain got narcotics in 2005, compared with 23% in 1993, a change reflecting new methods to curb addiction and other side effects. At the same time, whites were about one-third more likely to get morphine or other opiate drugs than blacks. Some doctors fear patients will become addicted or will feign pain to get drugs, and minority patients in severe pain were most likely to be untreated as a result, researchers wrote in today's Journal of the American Medical Association.

The most likely explanation for racial differences is "a true disparity in prescribing, with differential under-treatment of pain in minority patients," wrote doctors led by Mark J. Pletcher, an epidemiologist at the University of California at San Francisco. "This variability may partially result from racial/ethnic bias." The irony is that blacks are the least likely group to abuse prescription drugs, said Linda Simoni-Wastila of the University of Maryland School of Pharmacy in Baltimore. 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 new study examined 156,729 emergency room reports of patients in pain from 1993 to 2005. In those visits, about 31% of whites got opiates compared with 23% of blacks. "We have the technical means to control pain, and unfortunately it too often goes unused," said Allyn L. Taylor, an international lawyer at Georgetown University Law Center in Washington. "This is tragic and inhumane, particularly in the United States, where we have the resources to resolve it." Taylor and two Georgetown colleagues wrote an editorial accompanying the study.

Asians and Hispanics also were less likely than whites to get opiates painkillers including fentanyl and oxycodone, the study said. In 2005, about 40% of whites in pain got opiates during emergency room visits, compared with about 32% of nonwhites, the study said. 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. Doctors from the University of Alabama at Birmingham and the Mills-Peninsula Medical Center in Burlingame, California, contributed to the study, which was financed by the U.S. Agency for Healthcare Research and Quality and the National Institute on Drug Abuse. "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 of they're not being honest with themselves," he said. This story was compiled from reports by Bloomberg News and The Associated Press findings.

The study reviewed 156,729 emergency room reports of patients in pain between 1993 and 2005. In those, about 31% of whites got opiates compared with 23% of blacks minorities. Asians and Hispanics also were less likely than whites to get opiates painkillers including fentanyl and oxycodone, they study said. In 2005, about 40% of whites in pain got opiates during emergency room visits, compared with about 32% of nonwhites, the study said.

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