Home Health Glenn Ellis Ellis: Pain is Real, so is Medical Bias

Ellis: Pain is Real, so is Medical Bias

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By Glenn Ellis

Pain is a very real thing; but so is medical bias.

I found out, first-hand, what I had read and heard about for a long, long time: Some doctors believe black people have an ability to be strong and tough out painful conditions, and therefore do not give them the meds they need.

Racial disparities in all health outcomes are still commonplace in the United States, and one way this is apparent is the differences in how African Americans receive medication for opioid addiction treatment.

In recent years, the opioid crisis has impacted the lives of millions of Americans. Oftentimes, those impacted by opioids are portrayed as white, middle class Americans who receive treatment upon enduring non-fatal overdoses.

According to PBS, “roughly 80 percent of American’s opioid overdose victims are white.” This means that people of color make up only 20 percent of opioid overdose victims. Despite this, much of the attention is on, and continues to be on, white victims of the crisis. Research has shown, conclusively, that African Americans are administered pain medications less frequently than whites.

There are those who would like to dismiss this claim and find all kinds of reasons to justify this pattern. Some attribute it to a natural tendency of African Americans to exhibit behavior that is described as “drug seekers.” These are people who misuse prescription drugs most commonly seek prescriptions for opioids and benzodiazepines; drugs that, when abused can get you “high.”

However, even though there is a growing body of evidence to silence these skeptics, the institutional bias of prescribing less pain medications for African Americans persists. Recently, I found myself personally “victimized” by this experience in a clinical encounter.

Without going into too much detail (and taking up too much space in this column), following a minor laceration on my leg that was healing a little too slow for me, I made an appointment with a wound care doctor.

Upon being examined by the doctor, I described the history of the injury, how long ago it happened, and how painful it was; especially at night. I emphasized that it had disrupted my ability to sleep for almost two weeks. I told him that my attempts to get relief from over-the-counter acetaminophen (Tylenol) and ibuprofen (Advil) were doing nothing.

I expressed my concern about the possible kidney or liver damage that results from taking too much of either of these medications. The doctor, even though listening intently to me, looked at me with suspicion, proceeded to clean and dress the wound, gave me a follow-up appointment in two weeks, and never addressed the pain.

Now, as you can imagine, even though I’m not a doctor, I knew enough to understand that based on my description of what I was dealing with, at some point the doctor should address the management of the pain in the healing process that I was experiencing.

I guess this doctor thought that I was a patient seeking drugs for myself, or to pass on to a family member or friend with dependency issues. Or maybe he thought I was trying to get drugs to sell on the street. Drug-seeking behavior is a commonly used, although poorly defined, term that describes a range of activities directed towards attainment of sought-after drugs. It seemed to be beyond his belief that I was genuinely just trying to manage my pain.

Opioids are narcotics, there were other options the doctor could have prescribed.

 

‘…Worse For Blacks”

 

There are mounds of evidence to support this attitude by the medical establishment as it relates to African Americans and pain medications:

A 2017 report released by the Agency for Healthcare Research and Quality stated, “Overall access to efficient health care was worse for blacks than whites.”

A 2015 study showed African American children in the emergency room for appendicitis were less likely to receive any pain medication for moderate pain and less likely to receive opioids for severe pain.

A 2016 study found that medical students believe that African American’s nerve endings are less sensitive than white people’s nerve endings. In other words, they felt that “black people’s skin is thicker than white people’s skin”.

As most of you know, or have heard, the opioid epidemic that has hit this country has fueled the drug addiction rate, that has received national attention in large part due to the impact it has in white communities.

As crazy as it may sound, the medical community relies on a flimsy justification for this pattern of denying appropriate pain medication to African Americans. There is a report that has determined that denying prescriptions to African Americans for pain, 14,000 lives were spared from opioid abuse (or overdose).

As reported in the New York Times, “When the opioid crisis began to escalate some 20 years ago, many African Americans had a layer of protection against it. But that protection didn’t come from the effectiveness of the American medical system. Instead, researchers believe, it came from racial stereotypes embedded within that system. As unlikely as it may seem, these negative stereotypes appear to have shielded many African Americans from fatal prescription opioid overdoses.”

The only person who can judge the effectiveness of pain relief is the person who feels the pain, but African Americans’ pain is at the mercy of medical bias. The struggle is real, and the struggle continues…

Glenn Ellis, is Research Bioethics Fellow at Harvard Medical School and author of Which Doctor?, and Information is the Best Medicine. For more good health information visit: www.glennellis.com.