"But there appears to be this persistent gap in prescribing [of opioids] for whites and nonwhites, and the disparity is just as large now as it was a decade ago; it didn't shrink with the increase in prescribing opioids."
Specifically, over the 13-year survey period, the likelihood that a white patient complaining of pain would receive the pain medications from an emergency room doctors was 31 percent, while black and Hispanic patients only received the drugs 23 percent and 24 percent of the time, respectively.
In 2005, opioid-prescribing rates in the emergency department were 40 percent for white patients and 32 percent for all other patients.
Pam Kedziera, clinical director of the Pain and Palliative Care Center at Fox Chase Cancer Center in Philadelphia, Pa., says the findings underscore an inherent prejudice within the medical system.
"Nonwhites going to an ER are often labeled as drug seekers and their pain is ignored," Kedziera said. "Unfortunately, all nonwhites — even the affluent, educated, employed group— have reported that they are viewed differently than white [patients]."
"There is a bias in our health system to be more concerned with potential diversion problems than to be concerned about good pain management."
Although a standardized pain assessment tool is used by physicians in determining which patients should be prescribed pain medication, much of the pain-management decision-making remains subjective and therefore vulnerable to the influence of racial bias.
According to Ferdinando Mirarchi, medical director and director of operations of the department of emergency medicine at Hamot Medical Center in Erie, Pa., each patient visiting the emergency department with a complaint of pain is asked to rate their pain on a scale from zero to 10, with 10 being the worst pain.
"But just because a patient complains of 10 out of 10 pain does not mean that the use of narcotics is warranted," Mirarchi explained. "I once had a patient tell me he needed a shot of Demerol just so he could get a tetanus shot for an abrasion."
"Couple pain management with abuse potential, and physicians are more reluctant to prescribe narcotics."
Another point of subjectivity in assessing a patient's pain is based on how well a minority patient can communicate their pain to a white doctor.
"Racial differences between patient and physician have been shown to affect assessment, treatment and compliance with [pain-related treatment] recommendations," said Dr. Sabine Kost-Byerly, director of the pediatric pain management in the department of anesthesiology and critical care medicine at Johns Hopkins University in Baltimore.
"I wonder how well providers of a particular race can read nonverbal cues, such as facial expressions, of another race. … If a patient states that their pain is severe, but [their] facial expression does not support this, or the physician cannot read the patient's facial expression, then no treatment or less treatment will be offered."
Additionally, some doctors believe that certain minority groups may be reluctant to express their pain to doctors because their culture holds a negative stigma on displaying such signs of weakness.