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Hispanics and other groups less likely to
get strong pain medications in hospital
ROCKVILLE, Md., Jan. 1 /PRNewswire-USNewswire/ -- 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
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, will be 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
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
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
The study is based on data compiled by the
National Hospital Ambulatory Medical Care
Survey, which is administered by the U.S.
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
-- 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
-- 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
"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.
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