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Study documents racial variations in the prescribing of opioids by ER doctors

A study of 67,487 patients seen in U.S. emergency departments (EDs) between 1997 and 1999 found no differences in the receipt of pain relievers by white, black, and Hispanic ED patients reporting pain. However, blacks and Hispanics were 28 percent less likely than whites reporting similar severity of pain to receive an opioid analgesic, regardless of differences in insurance coverage. The study was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00059).

Physicians must trust patients not to abuse opioids, which are potentially addictive. Problems in patient-provider communication and concerns about credibility and trust may account for at least some of the differences in opioid prescribing seen in this study, notes lead investigator Joshua H. Tamayo-Sarver, Ph.D., of Case Western Reserve University.

Dr. Tamayo-Sarver and his colleagues analyzed data from the 1997, 1998, and 1999 National Hospital Ambulatory Medical Care Survey of a national sample of ED patients. The researchers found that blacks were less likely than whites to be prescribed opioids if assessment of their condition and level of pain was primarily dependent on patient report, such as migraines, or partially on patient report, such as back pain.

However, blacks were as likely as whites to be prescribed opioids for long bone fractures, which are known to cause severe pain and whose pain assessment depends on objective findings rather than patient report. There were fewer differences in opioid prescriptions for Hispanics and whites for these three conditions, but the power to detect differences was limited by the few Hispanics in the study with these diagnoses.

The Joint Commission on Accreditation of Healthcare Organizations has recommended routine use of a pain-rating scale at the time that vital signs are taken in the ED. This may help address the widespread problem of inadequate pain control in the ED (between one-sixth and one-third of patients diagnosed with one of the three conditions in this study did not receive or were not recommended for any analgesic). However, it is unclear whether use of a pain-rating scale will achieve greater equity of analgesic prescription across all racial/ethnic groups.

See "Racial and ethnic disparities in emergency department analgesic prescription," by Dr. Tamayo-Sarver, Susan W. Hinze, Ph.D., Rita K. Cydulka, M.D., M.S., and David W. Baker, M.D., M.P.H., in the December 2003 American Journal of Public Health 93(12), pp. 2067-2073.

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