In the 1990s, when opioid painkillers came on the market, providers were led to believe that these medications would not cause addiction. More and more patients were given prescriptions, and this led to widespread misuse. In 2016, per the U.S. Department of Health and Human Services, 116 people died every day of an opioid-related drug overdose.
No one would argue against the fact that the present opioid situation in our country is a problem. More and more babies are being born with withdrawal symptoms secondary to their mother’s opioid use or misuse during pregnancy. Per the Centers for Disease Control and Prevention, emergency room visits for opioid overdoses rose 30 percent in all parts of the U.S. from summer 2016 to early fall 2017. This trend was most notable in the Midwest, with a 70 percent average increase.
Because of this crisis, doctors, pharmacies, and emergency departments are changing their practices in order to curb the epidemic. Prescribers are no longer dispensing large quantities of opioids, pharmacies are tracking prescriptions more closely, and patients are being encouraged to lock up their narcotics to deter theft. Furthermore, Medication-Assisted Therapy (MAT) is now available for patients struggling with narcotic addiction. Though demand outweighs the availability, communities are discussing ways to make MAT readily available.
However, what is not making the water cooler discussion groups is a recent article by Yale researchers noting racial disparities in prescribing opioids for chronic pain. Over a 10-year span, data was analyzed from about 15,000 patients from the Veterans Administration’s electronic health records. The researchers looked at whether or not patients who were prescribed a narcotic were screened for illicit drug use. The second research question looked at whether the narcotic was discontinued if illicit drugs were uncovered.
Though there were few patients who were actually tested for illicit drugs, blacks were more likely than other groups to be tested at three-, six- or nine-month intervals. When patients tested positive for opioids or marijuana, the majority of them were allowed to continue taking their pain medication. In contrast, blacks who tested positive for cocaine or marijuana were two to three times more likely than other groups to have their pain medication discontinued.
This Yale study is consistent with other studies that show disparities in how blacks and whites are treated. It is believed that racial stereotyping may have contributed to this healthcare disparity. More research is needed in patients with chronic pain who also suffer from substance use disorder.
It has also been observed that during the crack epidemic families were ripped apart when large numbers of men and women were sent to prison for possession. It was a criminal offense then, but now it is a public health crisis. Many activists speculate that race plays a major factor in that as well.
As in all health-related circumstances, advocates are always needed to help hold the medical community accountable for fair and just care for all. Controlling pain and treating addiction should be available for everyone.
Denise Hooks-Anderson, M.D., is an associate professor at SLUCare Family Medicine and the medical accuracy editor of The St. Louis American. Email yourhealthmatters@stlamerican.com.
