Inside Racial Disparities In Opioid Prescribing, Drug Testing

By Kelly Burch 08/29/18

Black patients who tested positive for marijuana were twice as likely to have their pain pills discontinued than their white counterparts.

Image: 
black patient talking to a white doctor

Black patients who are prescribed opioids for chronic pain are more likely to be tested for illicit drug use than their white counterparts.

Black patients are also more likely to have their pain medication discontinued if they test positive for other substances, including marijuana, according to new research. 

The research, conducted at Yale, analyzed the health records of 15,000 patients in the Veterans Administration between 2000 and 2010. The Centers for Disease Control and Prevention (CDC) recommends testing patients who receive opioids for illicit drug use, but the researchers found that doctors rarely enforce the policy.

However, when the drug-testing policy was enforced, it was more likely to be applied to black patients. 

In addition, black patients were more likely to have their opioid prescriptions discontinued if they tested positive for marijuana or cocaine. Ninety percent of people who tested positive for illicit substances kept their opioid prescriptions, but black patients were twice as likely to have their pain pills taken away. 

"If they were black and tested positive for marijuana, they were twice as likely to have opioids discontinued, and for cocaine, they were three times more likely," lead study author Julie Gaither told Science Daily

Gaither blames this on lack of consistent policy and engrained biases. 

"There is no mandate to immediately stop a patient from taking prescription opioids if they test positive for illicit drugs," Gaither said. "It's our feeling that without clear guidance, physicians are falling back on ingrained stereotypes, including racial stereotyping. When faced with evidence of illicit drug use, clinicians are more likely to discontinue opioids when a patient is black, even though research has shown that whites are the group at highest risk for overdose and death.”

Having an established protocol for what to do when a patient tests positive for illicit substances could help address biases, Gaither said. 

“This study underscores the urgent need for a more universal approach to monitoring patients prescribed opioids for the concurrent use of sedatives and other substances that may increase the risk of overdose," she said. 

However, even with a policy in place, minorities may still face discrimination when it comes to drug testing, something many black Americans experience regularly.

In July, tennis great Serena Williams tweeted her frustration at being tested for drugs more than twice as often as her competitors. 

“It’s that time of the day to get ‘randomly’ drug tested and only test Serena. Out of all the players it’s been proven I’m the one getting tested the most. Discrimination? I think so,” she wrote. 

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.

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