The new study from the University of Greenwich looked at data from US Emergency Departments Across 1999-2020 and found substantial differences in how Black and White patients were treated for pain.
The authors examined over 200,000 records of patients treated for pain in the emergency department across 1999-2020 using data from the National Hospital Ambulatory Medical Care Survey, a large annual sample of visits to hospitals in the USA. They found that White patients were 26% more likely to be prescribed opioid pain medication than Black patients, even after accounting for any differences in pain severity, insurance status, age and hospital location. They also found little change in this disparity across time.
Despite the well-known risks of opioids, the appropriate use of opioid medication can provide significant pain relief and is generally accepted as an essential component of pain control in the emergency department.
More work needs to be done to identify the reasons behind the prescribing disparity to make sure everyone receives optimal treatment"
Dr Trevor Thompson, lead author of the study
Reasons for prescribing differences are uncertain, but have been suggested to include unconscious bias, inaccurate perceptions that Black people feel less pain or are more likely to misuse opioids, or even cultural differences in willingness to accept opioid medication.
Whatever the underlying causes, it seems evident that political initiatives to tackle inequities have not translated to real-life change in pain treatment, at least in the emergency department.
While a careful balance must be struck between risks and benefits of opioids, further work to identify the most important contributory factors to racial disparities in prescribing is critical to inform future strategies and provide optimal treatment.
Thompson, T., et al. (2023) Trends in Racial Inequalities in the Administration of Opioid and Non‑opioid Pain Medication in US Emergency Departments Across 1999–2020. J Gen Intern Med. https://link.springer.com/epdf/10.1007/s11606-023-08401-2.