Wednesday, January 02, 2008

Study finds racial gap in treatment of pain by physicians in ER --

CHICAGO - Emergency room doctors are prescribing strong narcotics
more often to patients who complain of pain, but minorities are less
likely to get them than whites, a new study finds.
Even for the severe pain of kidney stones, minorities were prescribed
narcotics such as oxycodone and morphine less frequently than whites.

The analysis of more than 150,000 emergency room visits over 13 years
found differences in prescribing by race in both urban and rural
hospitals, in all U.S. regions and for every type of pain."The gaps
between whites and nonwhites have not appeared to close at all," said
study co-author Dr. Mark Pletcher of the University of California at
San Francisco.

The study appears in today's Journal of the American Medical

Prescribing narcotics for pain in emergency rooms rose during the
study, from 23 percent of those complaining of pain in 1993 to 37
percent in 2005.

The increase coincided with changing attitudes among doctors who now
regard pain management as a key to healing. Doctors in accredited
hospitals must ask patients about pain, just as they monitor vital
signs such as temperature and pulse.

Even with the increase, the racial gap endured. Linda Simoni-Wastila
of the University of Maryland School of Pharmacy in Baltimore said
the race-gap finding might reveal some doctors' suspicions that
minority patients could be drug abusers lying about pain to get

The irony, she said, is that blacks are the least likely group to
abuse prescription drugs. Hispanics are becoming as likely as whites
to abuse prescription opioids and stimulants, according to her
research. She was not involved in the current study.

The study's authors said doctors might be less likely to see signs of
painkiller abuse in white patients, or they might be undertreating
pain in minority patients.

Patient behavior might play a role, Pletcher said. Minority patients
"may be less likely to keep complaining about their pain or feel they
deserve good pain control," he said.

Stricter protocols for prescribing narcotics might help close the gap.

A New York hospital recently studied its emergency patients and found
no racial disparity in narcotics prescribed for broken bones.
Montefiore Medical Center aggressively treats pain and is developing
protocols for painkillers that dictate initial dosages and times to
check with patients to see whether they need more pain medicine, said
Dr. David Esses, emergency department associate director at Montefiore.

Such standards might eliminate racial disparities, Esses said.

In the study, opioid narcotics were prescribed in 31 percent of the
pain-related visits involving whites, 28 percent for Asians, 24
percent for Hispanics and 23 percent for blacks.

Minorities were slightly more likely than whites to get aspirin,
ibuprofen and similar drugs for pain.

In more than 2,000 visits for kidney stones, whites got narcotics 72
percent of the time, Hispanics 68 percent, Asians 67 percent and
blacks 56 percent.


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