That racism and implicit bias have affected and infected the American medical community—and the way patients are treated—is not news. But thanks to a slew of recent studies, we know in greater detail how and where those impacts can be felt.
A new study led by Yale researchers adds to this growing body of evidence; this time in the area of opioid abuse.
According to a study released last week (h/t the Huffington Post), black patients on prescription opioids were more likely than their white peers to be drug tested by their doctors.
Researchers pulled from electronic health records from the U.S. Department of Veterans Affairs, analyzing more than 15,000 patients who received long-term opioid therapy between 2000-2010.
While the Centers of Disease Control recommends that patients on opioid prescriptions be tested for illicit drug use, researchers found very few opioid patients were tested. But when they were, doctors were twice as likely to have black opioid patients tested than their white counterparts.
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And, once they were tested, black patients were also more likely to have their pain medication discontinued. The study found that black patients who tested positive for marijuana had their opioid prescriptions stopped at two times the rate of white patients who tested positive. Black patients who tested positive for cocaine were three times more likely to have their meds discontinued. This despite the fact that white people are more likely to die from opioid overdoses.
It should be noted that 90 percent of patients, overall, were able to continue on opioid medication despite testing positive for other illicit drugs.
The primary author of the study, Julie Gaither, says the findings also point to a general lack of guidance when it comes to treating the pain of illicit drug users.
“There is no mandate to immediately stop a patient from taking prescription opioids if they test positive for illicit drugs,” Gaither explained on the Yale News site.
“It’s our feeling that without clear guidance, physicians are falling back on ingrained stereotypes, including racial stereotyping,” she said.
The study supports the widespread belief that white drug users are treated with more care and sympathy than black people who use drugs. Many have compared the different government responses to the opioid crisis, seen as largely affecting poor white people, and the crack epidemic, which disproportionately impacted black neighborhoods. In the latter case, black people were aggressively prosecuted for their drug use in a way white opioid users have not been.
The Yale study also gives us another look into how implicit bias can affect health outcomes along various lines of identity. Recent articles and studies have illuminated how black women are more likely to die during and immediately after pregnancy (while maternal death numbers have gone up for all American women, black mothers have been disproportionately affected for decades).
Another recent study reveals how implicit bias operates on gender lines as well, finding that women are more likely to survive heart attacks if they’re treated by female doctors; this was largely because of how male physicians “appear to have trouble treating female patients,” the research team wrote.