Opioid Disparities Shed Light on Potential Implicit Bias in Medicine
Researchers posit unequal opioid prescribing habits for Black and White patients in the same hospital are driven in part by implicit bias in medicine.
“Prescribers are challenged to balance these risks with their desire to relieve suffering,” the researchers wrote.
“Historically, this search for balance manifests as more liberal use of opioids for White patients than for Black or Brown patients. Given the complicated trade-offs, we do not yet know which group has fared better overall, but it is hard to imagine that the influence of race in these decisions — given that there is no known physiologic basis — reflects high-quality, equitable care.”
The team noted that limited opioid prescriptions might be protective for Black and Brown people, but that kind of paternalistic approach ignores the very real pain some Black and Brown patients experience.
The team sought to better understand differences in opioid prescriptions by looking at prescribing rates in Medicare patients ages 18 to 64 in and across healthcare organizations. By looking at a population comprised largely of workers with a disability, and by zeroing in on trends within a single institution, the researchers sought to better identify how disparities are playing out.
By and large, those disparities are stark. The team found that White patients were more likely to receive an opioid for pain management than Black patients. And even when Black patients did get an opioid prescription, chances are their White counterparts got a higher dosage. These trends were relevant even among those receiving care within the same hospital.
Across 310 different health systems, 50 percent of Black patients and 52 percent of White patients got any opioid prescription, a statistically significant but small difference, the team said. However, when looking at dosage, there was a bigger discrepancy. The mean annual dose was 36 percent lower for Black people than it was for White people, the team said.
Those findings rang true even when looking at an individual health system. Although the rate of opioid prescription receipt was only slightly lower for Black patients than White patients, 91 percent of health systems prescribed higher doses for White patients than Black.
For three-quarters of health systems, the annual mean dose for Black patients was at least 15 percent lower than for White patients.
The researchers did not investigate the reasons for these disparities, they emphasized as a caveat. That is a critical area for further research.
However, they did posit that implicit bias in medicine could be at play here.
“These opioid-receipt patterns probably reflect both overtreatment of White patients and undertreatment of Black patients,” the researchers wrote. “The findings should prompt systems to explore the causes and consequences of these biased patterns and to develop and test efforts to eliminate the influence of race on the receipt of pain treatment.”
“Could these findings result from something other than racial bias?” they continued. “We do not have the nuanced clinical data necessary to assess the appropriateness of the observed patterns of opioid receipt. Even when clinical data are available, the quality of pain management is hard to assess owing to the complex nature of this care.”
Previous literature about conscious and unconscious bias in medicine suggest to the researchers that those issues could be at play. For example, the medical field has been plagued by common, untrue myths that Black patients experience less pain than White patients, or that they are more likely to misuse opioid drugs. Although proven untrue, these notions could obscure clinicians’ prescribing decisions.
Additionally, poor patient-provider relationships could be erecting barriers. Particularly, patient-provider racial discordance—when the patient and the provider are of difference races—can sometimes lead to poor patient trust, limited empathy, and stunted communication, the researchers said. In turn, that could lead to unequal and potentially ineffective pain management prescribing practices.
And this could move even further beyond the interpersonal patient-provider interaction.
“We expect that systemic structural racism contributes as well,” the researchers posited. “Such systemic factors may include, for example, racially segregated neighborhoods and a lower density of pharmacies and continuity care clinics in predominantly Black neighborhoods than in predominantly White neighborhoods.”
Again, the researchers emphasized the limited evidence they have regarding implicit bias in medicine and the role it might play in opioid prescribing disparities. This is a crucial area for further research, they reiterated.
“We do not know whether or how these differences affect patient outcomes, because both opioid underuse and overuse can cause harm. We do know that skin color should not influence the receipt of pain treatment,” the researchers concluded.
“Our overall observations and system-specific reporting should prompt action by providers, health system administrators, and policymakers to explore root causes, consequences, and effective remediation strategies for racially unequal opioid receipt.”
Filed under: General Problems
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This article is based on a preconception that we are in an opioid crises to begin with. That is not the case in 2023 and it hasn’t been for several years. We are waging a war on illicit fentanyl and its analogues. The number of prescription opioids has been cut by at least 40% and many chronic pain patients have been cut off or severely tapered off of their pain medications.
Our country is riddled with racism in almost every walk of life. Many people don’t even recognize it when it’s right in front of them.
The medical field is still largely made up of white males. Women have been treated differently from their male counterparts throughout history. It’s a male dominated field and it has negatively impacted women and POC as long as it’s been around. I have no doubt that POC are not being treated adequately or the same as their white counterparts. This is also the case for younger people. They are frequently dismissed as having nothing wrong with them simply because of their age. They are treated like children that have no self-control or they lack the ability to take medications properly.
I’m quite certain that I have failed to mention everyone who has been treated the same way.
It’s the system that’s at fault. It’s was designed by wealthy white men. It’s also regulated by the same type of people. Women are POC have always gotten the short end of the stick.
Especially when it comes to being treated. The old negative views from long ago are still at play in regards to anyone who isn’t a wealthy white man. I’ve had significant health issues since childhood and being diagnosed weren’t made for years and years. I can’t speak from the POC point of view, but I am quite certain that POC have been treated differently than their white counterparts. When new drugs are created and tested they use white males to test and then their results are used for all.
Even though we know that people of a different
race and background may not react the same way. Metabolism, weight, and genetics all play a part in the way we assimilate medications. Things are beginning to change but it’s going to be slow in a time when we have lost our patience with the entire healthcare system. It was based in disparity and it has continued. Whether it’s racism, sexism, or something else it has never been fair and equal for all. It kinda epitomizes the way so many governmental agencies are biased and bigoted. It’s definitely treating minorities differently and usually not as well as others. But these issues are present in everyday life. Our entire culture is so brainwashed that many people will never recognize what I’m talking about. The world doesn’t revolve around white males. I guess they haven’t gotten that memo. I can’t just talk about any one thing that’s wrong with our healthcare system. They are all important issues that need to be dealt with in a productive, transparent way.
I agree with this about the disparity between the races. But, what about when the provider is Brown, and the patient (me) is White? It’s interesting that nobody has addressed this issue.
Perhaps this racial difference is the real reason for the grouchy, dismissive attitude of the Brown provider, resulting in my under treated intractable pain.