RACIAL DIVIDE FOUND IN PAIN PRESCRIPTIONS

White People Are More Likely Than Minorities to Get Narcotics From
Emergency-Room Doctors, a Study Found.

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, San Francisco.

The study appears in Wednesday's Journal of the American Medical
Association. 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, Baltimore, School of Pharmacy said the
race gap finding may reveal some doctors' suspicions that minority
patients could be drug abusers lying about pain to get narcotics.

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 may be less likely to see signs of
painkiller abuse in white patients, or they may be under-treating pain
in minority patients.

Patient behavior may 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 may 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 if they need more pain medicine, said Dr.
David Esses, emergency-department associate director at Montefiore.

Such standards may 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.

The data came from a well-regarded government survey that collects
information on emergency-room visits for four weeks each year from 500
U.S. hospitals. The new study was funded by federal grants.

"It's time to move past describing disparities and work on narrowing
them," said Dr. Thomas L. Fisher, an emergency-room doctor at the
University of Chicago Medical Center who was not involved in the study.

Fisher, who is black, said he is not immune to letting subconscious
assumptions inappropriately influence his work as a doctor.

"If anybody argues they have no social biases that sway clinical
practice, they have not been thoughtful about the issue or they're not
being honest with themselves," he said.