Is Racism ‘Saving’ Black People From Opioid Overdoses?

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A number of studies have shown that white people — and, worse, white doctors — tend to underestimate the amount of pain black people feel. As a result of the so-called superhumanization bias, white people tend to believe black people can grin and bear it when faced with pain that would cause white people to crumple.

At the Washington Post, Sandhya Somashekhar sums up a new study in Proceedings of the National Academies of Science that sought to better understand how often the general public as well as medical students and residents bought into certain myths about black/white differences.
Somashekhar explains:

Researchers at the University of Virginia quizzed white medical students and residents to see how many believed inaccurate and at times “fantastical” differences about the two races — for example, that blacks have less sensitive nerve endings than whites or that black people’s blood coagulates more quickly. They found that fully half thought at least one of the false statements presented was possibly, probably or definitely true.

Moreover, those who held false beliefs often rated black patients’ pain as lower than that of white patients and made less appropriate recommendations about how they should be treated.

The study… could help illuminate one of the most vexing problems in pain treatment today: That whites are more likely than blacks to be prescribed strong pain medications for equivalent ailments.

If you actually look at the findings, among the most experienced group studied — residents — these beliefs actually weren’t all that frequently held. A quarter of residents believed that “Blacks’ skin is thicker than whites’, and the next-most-endorsed false item was “Blacks age more slowly than whites,” at 14 percent of residents. (The online sample of non-med students, perhaps unsurprisingly, endorsed these beliefs at significantly higher rates.)

That said, there’s solid evidence from elsewhere that black patients’ and patients’ pain really is treated differently. “[A] 2000 study out of Emory University found that at a hospital emergency department in Atlanta, 74 percent of white patients with bone fractures received painkillers compared with 50 percent of black patients,” Somashekhar notes. “Similarly, a paper last year found that black children with appendicitis were less likely to receive pain medication than their white counterparts. And a 2007 study found that physicians were more likely to underestimate the pain of black patients compared with other patients.”

All of this suggests, in addition to the obvious takeaway that doctors need to root out their bias in treating black patients, an interesting possibility. We know that middle-age American white people have been dying at a rather shocking rate in the U.S., and that this has been driven in part by opiate overdoses. We also know that, as per the CDC, “Overdose rates were higher among non-Hispanic whites and American Indian or Alaskan Natives, compared to non-Hispanic blacks and Hispanics.”

So maybe, amid the other reasons African-Americans are less likely to die from these overdoses — less access to health care and therefore opioids in the first place — part of the answer is that doctors’ false, racist belief that black people can grit out more pain than white people causes them to prescribe black patients fewer opioids, which leads to less addiction and fewer overdoses.

That obviously doesn’t justify a doctor not doing everything he or she can, within reason and balancing concerns over opioid misuse, to manage a patient’s pain. But it’s still weird to think about racism “accidentally” preventing deaths.