Doctors Prescribe Fewer Painkillers to Black Kids

Physicians recognize pain in kids of all races, but responses vary.

America’s race issues aren’t just affecting children in schools; they’re affecting kids in hospitals as well. A new study published today in JAMA Pediatrics supports the conclusion that black kids are prescribed pain medication with less frequency than white kids in the country’s emergency rooms.

While researchers have documented racial disparities in hospital wait times, admission rates, and pain management before, this is the first time prejudicial practices towards children have been documented.

The new study, led by Monika K. Goyal of the Children’s National Health System, focused on kids under 21 with appendicitis, a condition so painful that physicians are almost universally in favor of prescribing opioids for relief. After adjusting for variables like age, ethnicity, sex, and pain level, the survey of almost 1 million children nationwide found that only 12 percent of black kids received opioids for appendicitis-related pain while 34 percent of their white counterparts did.

While the study showed that clinicians recognize pain equally across racial groups — prescription of painkillers overall showed no bias — the way they treated pain was skewed. Black children were prescribed far fewer opioid painkillers (codeine, morphine, oxycodone) than white children, even after controlling for pain levels. Non-opioid meds, like ibuprofen and acetaminophen, were more likely to be prescribed for black patients with similar levels of pain.

The authors refer to a similar study suggesting that opioid prescriptions came down to a physician’s trust in a patient. That study showed that if a doctor thinks a patient might take opiates for fun or sell them on the street, a prescription won’t be forthcoming. That’s not necessarily a problem unto itself, but coupled with the new results, that prior result may point to racism at play.

Opioid abuse among adults — of all races — is a problem pain specialists must constantly bear in mind when prescribing meds. What’s special about this study is that it’s focusing on appendicitis-stricken kids who, for the most part, probably aren’t out slinging Vicodin on the street. It’s troublesome enough that racial disparities in pain management have been documented in adults for years, yet nothing’s been done to change it. It’s not going to be a simple problem to fix. While we try, let’s leave the kids out of it.

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