Disparities/Minority Health

Blacks, Hispanics, and other minority groups are less likely to get strong pain medications in hospital emergency departments

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 supported in part by the Agency for Healthcare Research and Quality (HS16238). Opioids are narcotic pain medications used to treat patients with moderate to severe pain.

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.

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. Researchers analyzed the use of several commonly prescribed opioids, including hydrocodone, meperidine, morphine, codeine, and oxycodone.

While the use of opioids increased overall from 23 percent in 1993 to 37 percent in 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 compared with 32 percent of all others. Differences in prescribing between whites, Hispanics, and blacks 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.

The study did not conclude why Hispanics, blacks, and other minority groups were less likely to receive opioids but suggested racial and/or ethnic bias as a significant factor. However, the study authors note that the causes of disparities in medical care are complex, and simple racial/ethnic bias is unlikely to fully explain the problem.

The researchers indicate 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.

See "Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments," by Mark J. Pletcher, M.D., M.P.H., Stefan G. Kertesz, M.D., M.Sc., Michael A. Kohn, M.D., M.P.P., and Ralph Gonzales, M.D., M.S.P.H. in the January 2, 2008, JAMA 299(1), pp. 70-78.

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