Prescription Drug Abuse: Racial Differences in Pain Management
Pain medications are often prescribed for chronic pain related to other medical conditions, such as cancer or an injury that results in ongoing pain. In all cases, the prescription of a pain medication to relieve pain must be weighed against the potential negative consequences of using such a medication, including not only side effects but also the risk of addiction.
In addition, the pain is best managed when there are follow-ups to the prescription that include assessments of pain levels and examination of co morbid conditions. In a recent study, researchers led by Leslie R.M. Hausmann, PhD of the Veterans Affairs Pittsburgh Healthcare System and Assistant Professor of Medicine at the University of Pittsburgh discovered that there are significant disparities between races in how pain management is executed.
The researchers found that the differences are present in the monitoring of opiods and in the follow-up routines. The recommended guidelines include assessing patients for the effectiveness of the medication, as well as screening them for evidence of drug abuse. The study’s findings appear in a recent issue of the journal PAIN.
The study’s focus included several measurements of pain management defectiveness, including the physicians’ implementation of an opioid agreement, measurement of pain levels at follow-up exams, inclusion of urine screenings for drugs and referrals for pain clinics and substance abuse treatment.
The retrospective design incorporated health records representing 1,646 white patients and 253 black patients. The data was taken from electronic health records that met certain criteria. The patients were all prescribed opioids for pain not related to cancer at the Veterans Affairs Pittsburgh Healthcare System pharmacy and used the medication for at least 90 days. The records were all from October 2007 to September 2009.
The researchers also assessed data about prescription painkiller follow-up and monitoring practices for the 12 months following the prescription period, to form a complete profile of the pain treatment.
The patients were 94 percent male and 22 percent were over the age of 65. Forty-five percent were married or living with a partner, and were most commonly treated for joint or back pain. Approximately one half of the patients had a co morbid mental or physical health condition, and one-third of the patients had a past of substance abuse.
When comparing the patients, the black patients were younger, less liable to have pain in their back, and had more physical co morbidity and higher pain levels recorded. The black and white patients were similar in history of drug abuse.
However, major racial differences were discovered as pertained to monitoring of pain prescription use and the effectiveness of the medication. Black patients seemed less likely to be monitored for pain levels during medical exams and among those patients given a urinalysis, black patients were tested more often, and particularly if they were prescribed a higher dose of medication.
Black patients also were less liable to receive a referral to a specialist for pain treatment and were more likely referred to a substance abuse treatment facility after taking prescription opioids.
The findings indicate that when black patients are prescribed opioid medications for pain treatment, they may not be receiving similar follow-up and monitoring practices that may maximize the benefit of their pain management treatment.