A photo of a bottle of oxycodone, a type of opioid. The bottle is laying on a table with small, white circular tablets falling out of it.
Credit: BackyardProduction/iStock

Pain does not discriminate based on race or ethnicity, but a large study of major health systems across the United States suggests that a patient’s race likely plays a role when it comes to prescribing strong pain-relieving medication.

The study, published in the New England Journal of Medicine, analyzed Medicare claims data collected between 2016 and 2017 across 310 racially diverse health systems. Researchers sought to examine the differences in opioid prescriptions and doses between Black and white patients.

According to their findings, the number of prescriptions for opioid medications given to Black and white patients was about the same (50 percent for Black patients and 52 percent for white patients). When it came to dosage, however, things were very different. The average dose was higher among white patients in 91 percent of the health systems studied; most of the time, the dose was at least 15 percent higher.

“Black patients and white patients who were served by the same [hospital] system had very different patterns of opioid receipt,” the authors wrote. “These opioid-receipt patterns probably reflect both overtreatment of white patients and undertreatment of Black patients.”

Higher doses of opioids for everyone isn’t a good goal, as these drugs — especially when used for the long term and at higher doses — have a high rate of addiction and can open the door to abuse and overdose. And the discrepancies in opioid prescriptions may play a role in discrepancies in death rates: In 2019, 72 percent of opioid-related deaths occurred in white non-Hispanic people compared to 15 percent in Black non-Hispanic people, according to the Kaiser Family Foundation.

“There’s racial bias in the prescribing pattern,” lead study author Nancy Morden, MD, told Stat News. “If we found this in half of the hospitals, maybe you could imagine something else, but it’s 90 percent of hospitals. I was shocked when I saw that.”

“The results of this study, sadly do not come as a surprise to me,” says Sarah Shaw, BIPOC Patient Advocate, Community Outreach Manager at the Global Healthy Living Foundation. “I speak with many disabled and chronically ill Black patients who bring up the struggles of living with intense pain (long term and short term) but are constantly getting turned down by doctors for pain medication.”

In the conclusion of the study, the authors noted that previous research suggests that “such differences in practice may result from clinicians’ conscious and unconscious racial bias.” This kind of bias could be due to a grossly incorrect and outdated belief that Black people experience less pain than white people and are more likely to abuse opioids.

It could also stem from what the authors describe as “patient-physician racial discordance and the related potential for lower levels of empathy, trust, physician perception of patient’s pain, and effective communication.”

“Racial bias in health care absolutely contributes to Black patients being treated less and prescribed less pain medication than their white counterparts because those in the system have been taught that Black patients experience less pain or will abuse pain medication,” says Shaw.

These findings do not mean that doctors should start issuing the same prescriptions to every patient. After all, the decision to prescribe opioids (and how much to prescribe) is made on a case-by-case basis. Rather, they should be used by health care professionals to develop guidelines for assessing and managing pain, keeping racial disparities in mind.

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Interview with Sarah Shaw, BIPOC Patient Advocate, Community Outreach Manager at the Global Healthy Living Foundation.

Lloreda CL. In the same health system, Black patients are prescribed fewer opioids than white patients. STAT News. July 21, 2021. https://www.statnews.com/2021/07/21/black-patients-prescribed-fewer-opioids-white-patients.

Morden NE. Racial Inequality in Prescription Opioid Receipt — Role of Individual Health Systems. New England Journal of Medicine. July 22, 2021. doi: https://doi.org/10.1056/NEJMsa2034159.

Opioid Overdose Deaths by Race/Ethnicity. Kaiser Family Foundation. https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/.

Opioid Prescribers Can Play a Key Role in Stopping the Opioid Overdose Epidemic. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/improving-opioid-prescribing

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