Why Opioids Wreak Havoc on White Communities

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Photo by K-State Research and Extension via Flickr

Across California, a blessing has become a curse for patients who dwell in overwhelmingly white communities: their ready access to opioid pain relievers.

A new study of prescribing practices across all of California’s 1,760 ZIP codes helps explain why opiates, some of medicine’s most addictive drugs, have wreaked more havoc on white communities than on communities of color.

Researchers found that between 2011 and 2015, residents of neighborhoods with the highest proportions of white people were more than twice as likely to be prescribed an opioid pain reliever than were residents of neighborhoods where whites were most scarce.

The answer, at least in part, appears to lie in unconscious physician biases about race, ethnicity and pain that more typically leave minority patients underserved and under medicated, authors of the new study said.

The findings from California were published Monday in the journal JAMA Internal Medicine. They appeared alongside a report chronicling the changing racial mix of opioid fatalities in New York City and an analysis from the Centers for Disease Control and Prevention showing that while doctors cut their rate of opioid prescribing by 20 percent between 2015 and 2017, current levels remain almost three times higher than they were in 1999.

“The resulting disparity in care may have briefly shielded minority communities from harm,” said study leader Joseph Friedman, a medical student at UCLA.

“But for far longer and in many more instances,” he said, “systematic racism within the healthcare system has led to … insufficient treatment of minority patients’ physical and psychic pain.”

In ZIP codes dominated by whites who were not of Latino or Asian heritage, opioid prescriptions flowed freely during the study period. And they were by far most generously offered in low-income white communities.

However, in ZIP codes with the highest proportion of minority residents, not even high income levels could close a yawning race and ethnicity gap in opioid prescribing.

The result is now all too familiar: an epidemic that has cut a swath of death and destruction through poor, rural white communities while largely sparing minorities.

The new research offers a revealing glimpse of how addiction to opioids may have gained a foothold first in California’s rural white communities while largely bypassing black, Latino and Asian neighborhoods.

Researchers found that in each of the five years they studied, roughly 24 percent of Californians left a doctor’s office at least once with a prescription for an opioid narcotic.According to Friedman, leaving a doctor’s office with a prescription for opioids is at least a key marker of a person’s risk for addiction and death.

Collectively, findings like these suggest that something more subtle is at work than just money, insurance coverage and access to healthcare, experts said.

Researchers concluded that the results of their study provide important insights when trying to understand the prescription drug epidemic that is occurring in mostly white communities and the reported disparities in untreated pain, anxiety, and ADHD that are simultaneously found in minority communities.

Authors include: Joseph Friedman, MPH; David Kim, MD; Todd Schneberk, MD, MS; Philippe Bourgois, PhD; Michael Shin, PhD; Aaron Celious, PhD; David L. Schriger, MD, MPH.

See also: “Are Pain Doctors Wrongly Taking the Blame for the Opioid Crisis?”

Read the report here.

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