How Racial Bias Shielded Thousands Of Black Americans From The Opioid Crisis

Doctors are less likely to prescribe narcotics if a patient is black, and new analysis finds this racial bias has saved thousands of lives.

A study published in the journal Epidemiology concludes an estimated 14,000 black Americans would have died from the opioid crisis had they been prescribed the drugs at the same rate as their white counterparts.

Dr. Andrew Kolodny, director of opioid policy research at Brandeis University, says doctors prescribe opioids to fewer black patients for a few reasons. Studies show doctors are less sensitive to a black patient's pain, and some may worry that black patients will become addicted to or sell the medication.

A 2010 study found white Americans two times more likely to receive an opioid prescription than black Americans. Since pharmaceutical companies began aggressively marketing new prescription opioids in white rural areas in the 1990s, racial stereotyping has had a "protective effect" on black Americans, he says.

"The black patient is less likely to become addicted to opioids because they’re less likely to be prescribed," he says. "And they’re also less likely to have opioids in the medicine chest where family members could become opioid-addicted."

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Some studies that found black patients are prescribed opioids less frequently were sponsored by drug companies trying to persuade doctors to fill the gap, he says.

Though these findings seem like good news for black Americans, Kolodny says this bias harms white Americans.

If a doctor subscribes to stereotypes of what an addict looks like — nonwhite, from a low-income community — the physician may assume their white, middle-class patients are immune to addiction, he says.

"Rather than recognizing that addiction is a disease that can happen to just about anybody who’s repeatedly exposed to a highly addictive drug," he says, "they may just assume that addiction is something that happens to those people."

Doctors are not immune to racism, he says, but they should prescribe opioids cautiously to all patients. Opioids are not the only way to treat pain and getting a prescription does not equate pain treatment, he says.

More than 47,000 Americans died from an opioid overdose in 2017, according to the National Institute on Drug Abuse. Kolodny says he fears addiction stereotypes may continue to fuel this deadly crisis — one that kills more than 130 people in the U.S. every day, NIDA reports.

"If doctors continue to believe that addiction is an issue for a subset of our population who are interested in abusing drugs and behaving badly rather than understanding that addiction can be caused by exposure, I’m concerned that they’ll continue to overprescribe," he says.

Ciku Theuri produced and edited this interview for broadcast with Tinku Ray. Allison Hagan adapted it for the web.

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