Unconscious bias is likely the reason black patients receive fewer opioid prescriptions than white patients in the emergency department, researchers conclude.
Unconscious racial bias can happen anywhere. Now researchers have documented its presence in opioid prescribing.
Black patients who are seen in emergency departments for back or abdominal pain are roughly half as likely as white patients to be prescribed opioids in the emergency department or at discharge, according to the UC San Francisco-led research published in PLOS ONE.
Researchers reviewed national data gathered at EDs from 2007 to 2011. They scoured records from more than 60 million pain-related ED visits by adult, non-elderly patients, trying to determine whether patients were prescribed opioids in the ED or at hospital discharge.
Then they examined the data with an eye toward the patients' race and why they were in the ED.
The researchers divided patients who were in pain during their visit into two groups: Those with conditions that were "definitive" and could be objectively diagnosed, such as long-bone fractures or kidney stones that, and "non-definitive," which included back or abdominal pain.
Black patients who were seen for pain resulting from non-definitive conditions had roughly half the odds of being prescribed opioids in the ED or at discharge compared to white patients, researchers found.
For back pain, compared to non-Hispanic whites, non-Hispanic blacks had 0.67 and 0.58 times the odds of receiving an opioid prescription at discharge and opioid administration in the ED, respectively.
Among ED visits for abdominal pain, all racial-ethnic minorities had significantly lower odds than whites of receiving a prescription for opioids at discharge.
Subconscious Bias
The researchers found no race-based differences in opioid prescribing for definitive conditions, or for toothaches, which the group had initially classified as non-definitive, but for which the researchers suggest there are often visible signs, such as abscesses.
This study may be evidence of subconscious bias, the researchers say. They point to other studies that shows that "[r]acial-ethnic minority patients, especially non-Hispanic blacks presenting with vague conditions often associated with drug-seeking behavior, may be more likely to be judged as 'a drug-seeker' relative to a non-Hispanic white patient, presenting with similar pain-related" complaints.
Race-based disparities in healthcare are nothing new.
A study in Cancer Epidemiology, Biomarkers & Prevention found that minority women were more likely to have aggressive subtypes of breast cancer and were more likely to receive treatment that was not concordant with guidelines when compared with non-Hispanic white women.
A Kaiser Permanente study involving more than 7 million adults found that patients from most racial and ethnic minority groups had much lower rates of mental health diagnosis compared to non-Hispanic white patients, ranging from 64% lower for Asian patients to 28% lower for Hispanic patients.
The study also says, however, that such racial biases may be contributing "to widening of existing disparities in health, and possibly explain the enormous burden of opioid epidemic among non-Hispanic whites to a certain extent."
Alexandra Wilson Pecci is an editor for HealthLeaders.
