LOS ANGELES, Calif. — During the early days of the U.S. opioid crisis, doctors and patients alike were largely unaware of the addictive and harmful nature of the drugs. Now, researchers from the University of California-Los Angeles finds that between 2006 and 2015 doctors typically prescribed opioids more often to their white patients complaining about new-onset low back pain in comparison to their African-American, Asian, and Hispanic patients.
These findings allege, according to the research team, that many U.S. doctors were not exactly fair when it came to dispensing pain treatments, choosing to ensure Caucasians receive the drugs considered to be the best at that time. Meanwhile, doctors were more likely to prescribe patients of color less-powerful, non-steroidal anti-inflammatory drugs, or NSAIDs.
“This appears to be a case of differential treatment of pain or bias by physicians, in which the pain of certain patients deserves opioids and the pain of others does not,” says study author Dr. Dan Ly, an assistant professor of medicine at the David Geffen School of Medicine at UCLA, in a university release. “The fact that, in hindsight, more white patients developed dangerous long-term opioid use doesn’t absolve physicians of this differential treatment.”
Disparities among patients with chronic pain
Study authors analyzed nationwide medical claims data collected between 2006 and 2015 among roughly 275,000 Medicare beneficiaries ages 66 and older during this study. Each patient had contacted their doctors about new-onset low back pain. Most of these individuals were white (81%), followed by much smaller percentages of Black (6%), Hispanic (8%), and Asian/Pacific Islander (6%) patients.
That analysis led to the discovery that, on average, 11.5 percent of white patients received a prescription for opioids. However, only 10 percent of Black patients were prescribed opioids. Just nine percent of Asian/Pacific Islander patients and 10.5 percent of Hispanic patients received a prescription for these powerful pain-relievers.
Those percentages may not seem all that drastically different from each other, but when study authors looked specifically at patients living with severe or long-lasting pain, the findings were even more compelling. The team included patients who visited their doctor five or more times in a new analysis. While doctors prescribed 36 percent of white patients opioids, only 30 percent of Black patients, 21 percent of Asian/Pacific Islanders, and 24 percent of Hispanics received the same prescriptions.
Notably, researchers add that doctors also generally tended to prescribe opioids to their white patients faster than with other demographics. It’s also worth noting that white patients were more likely to become dependent on opioids in comparison to other ethnicities/races.
So why was this happening so much?
Study authors can’t say for sure, but question whether doctors assumed patients of color were more likely to abuse opioids. Prior research, however, shows no difference whatsoever in rates of opioid misuse between patients of color and Caucasians. Alternatively, researchers say it’s possible that white patients simply asked for opioids more openly and frequently than others.
Ultimately, this research is observational in nature, which means it did not account for all possibly influential factors. For example, researchers did not have access to patients’ physical exams, which may have influenced prescribing decisions.
The study is published in JAMA Health Forum.