Opioids, Illicit Drugs, and Physician Bias

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More than three years ago, researchers uncovered a troubling trend in the realm of pain management. There is compelling evidence of racial bias in emergency room settings, with black patients half as likely to be prescribed opioids for pain than white patients.

But in 2020, is racial bias still an issue in healthcare settings? Unfortunately, plenty of evidence exists that is indicative of continued physician bias. And, in some cases, that evidence has been twisted by the media to make it seem as though the healthcare industry’s inherent racial bias is a good thing. For example, news sources claim that an estimated 14,000 Black Americans would have died from misuse of opioids if they were prescribed those medications at the same rate as white patients.

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While there’s no denying that the threat of opioid overdose is very real within black communities, acting as though physician bias saves lives actually undermines overall health. Further, that denial effectively perpetuates systemic racism and excuses healthcare providers from the suboptimal medical attention widely given to black patients. Existing while black is a daily struggle for many, and physician bias only compounds what is already a complex and tired issue.

Eliminating Bias and Shame in Healthcare Settings

Physician bias goes much deeper than pain management, however; NPR recently reported that black mothers receive less treatment for postpartum depression than their white counterparts. Studies show that about 1 in 7 mothers struggles with postpartum depression nationally, yet a large chunk of those women suffers in silence. The shame of potentially being looked upon as a “bad” mother may be the primary reason that many women choose not to seek treatment for postpartum depression. This is amplified by intersectionality.

Shame, as well as the fear of judgment and of children being removed by child services, are especially prevalent among young, single, black mothers. For pregnant women who are also living with addiction, that fear and shame may be compounded even further. The stigma placed on drug use, coupled with problematic (and inherently racist) drug enforcement policies on a national level, may keep pregnant women from seeking prenatal care. That choice can be detrimental to the health of both the mother and her unborn child.

On that note, eliminating patient shame may be a core component in reducing physician bias and bringing greater equality to the healthcare industry. Among minority populations seeking pain management, shame may come from a variety of sources. For instance, patients struggling with addiction or who have previously suffered the indignity of physician bias may experience pronounced feelings of shame, as well as a general distrust towards healthcare providers.

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The Double Standard of Opioid Prescriptions

To better understand how we got to this point, where shame and racial bias are dominating forces in what should be a humanitarian industry, background may be useful. For instance, while sometimes used interchangeably, the terms “opioid” and “opiate” are not synonymous. The difference comes down to naturally derived versus synthetic compounds.

All opiates are opioids because they are naturally extracted from the opium poppy flower. Opiates include heroin, morphine, and codeine. Hydrocodone and oxycodone, common prescription pain medications, are classified as opiates as they are a synthetic drug related to opium.

This national dependence on opium derivatives is problematic in more ways than one. Healthcare providers may be conflicted as to whether the benefits of prescribing an opioid outweigh the inherent risks. Some physicians believe that opioids are the “most effective drugs for the relief of pain and suffering.” While that may indeed be the case, this class of drugs is highly addictive and dangerous when misused.

Opioid misuse is a multifaceted problem, and addiction often begins with prescription medication misuse, or the lack thereof. To help manage pain without a valid prescription, some people often turn to illegal channels to procure opioids. Others come up with creative solutions, such as substituting certain over-the-counter drugs that contain small amounts of opioids. Addicts have even been known to abuse the anti-diarrheal Imodium, which contains loperamide, a mild opiate.

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The above example illustrates just how far addicts are willing to go to get their fix and reiterates the importance of removing shame and bias. Nearly 40 states have implemented so-called Good Samaritan laws designed to allow addicts to seek treatment without fear of judgment or incarceration. The caveat, however, is that Good Samaritan laws only apply in the cases of an overdose or other medical emergencies.

Illicit Drugs and Overdoses: By the Numbers

Make no mistake: overdosing on opioids is an unfortunately common occurrence that doesn’t discriminate based on race, gender, or any other factor. Prescription pain medications (primarily opioids) were the cause of more than 20,000 overdose deaths in 2015 alone, reports the University of Southern California’s Keck School of Medicine.

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Overdose deaths occur more frequently in particular areas, notably the Midwest and the South. What’s more, there are a number of social and economic factors at play where opioid addiction is concerned. Drug abuse rates are higher among low-income populations, and it’s important to note that black communities have the nation’s highest poverty rate, at 27.4%. Issues such as sub-par medical care, doctor bias, substance abuse, and lack of trust towards doctors are effectively the name of the game for those struggling with income inequality.

Final Thoughts

From emergency room pain management to prenatal care, black patients continue to be left behind. And physician bias can kick off a vicious cycle where a patient self-medicates via illegal channels, gets hooked, but feels unsafe seeking treatment for addiction. Shame is also part of the addiction cycle, and eliminating that shame is the first step towards a healthier overall population and improved discussions about what’s at stake in a notoriously biased system.

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