Recently in my public health classes, we have been discussing racial disparities. Through this discussion, I realized that one of the biggest and most forgotten are the racial inequalities overlooked in prescription drug overuse. In fact, I learned that the rate of drug overdose has more than doubled since 1999, despite efforts at establishing overdose prevention programs to combat this crisis. More specifically, however, the prescription drug overdose rate affects white communities at a greater rate compared to other racial groups, due to racial inequality stemming from systemic racism/discrimination as well as certain socio-economic factors. When trying to fight this issue, the current administration is taking steps to stop over-prescription and increase treatment and recovery services, as well as strengthening criminal penalties for drug dealing. Unfortunately, this does not get to the root of the problem. To combat this issue to allow access to opioids to those in true need and to reduce overdose rates, racial sensitivity training for healthcare professionals to combat social bias must be initiated, and better access to healthcare must be created. Similarly, more updated and objective pain-monitoring methods should be utilized to prevent this disparity from occurring in the first place.
Currently, the rate of prescription drug overdoses is disproportionally affecting white communities. This is due to their “privilege” of unparalleled access to prescription opioids, illustrating how racially disparate drug policies and healthcare practices ultimately hurt certain demographics of patients. In fact, according to the National Institute on Drug Abuse, in 2017 alone, drug overdoses caused the deaths of over 70,000 people, with opioids being the main driver of this tragic statistic. Moreso, this is severely impacting the United States at an even greater rate than other first world countries. The United States has a drug overdose death rate two times higher than countries with similar overall socioeconomic standings such as Canada, the U.K and Australia. Additionally, prescription drug overdose mortality in the United States is 27 times higher than in countries such as Italy and Japan where opioid prescriptions have been tightly controlled due to public health initiatives. The United States lacks those public health initiatives that not only prevent overdose rates from increasing, but also the racial disparities associated with it.
With no sign of this issue leveling off, it seems that this important issue continuously affects white communities disproportionately. In fact, white Americans are making up roughly 80% of opioid victims. But to make that worse, nothing drastic is being done to combat the root of this racial inequality. While many argue that fixing this problem should begin with combating all overdoses at once, it is important to analyze patterns that are continuing this trend of overdoses.
This relates to any individual as this problem stems from underacknowledged societal beliefs that are resistant to change. Starting in the 1990s, new prescription opioids were marketed in white rural areas very heavily. Due to beliefs that minorities such as African Americans and Latinos were more likely to become addicted to the drugs, would be more likely to sell the drugs and had a higher pain threshold than white people because they were biologically different, they received fewer opioid prescriptions. This pattern is still being followed today partly due to preconceived notions about minorities taking opioids. This unconscious bias not only began fueling this disparity but continues it as well.
To combat this issue, society must change its unfair perspectives starting with healthcare professionals and governmental support. Sensitivity training for healthcare professionals that takes race into account should be enforced. Similarly, more objective methods to prescribe opioids that are government regulated would be beneficial in order to make healthcare professionals deter from their unintentional biases. This (hopefully continuous) top-down regulation from the government would then make non-healthcare professionals more consciousnesses of their beliefs about minorities. According to researchers, there is a possibility that some white doctors can be more empathetic to the pain of people who are like them, and less empathetic to those who are not. This can lead to healthcare professionals prescribing opioids to white patients more often than other races when prescriptions may not be necessarily needed, increasing the chance that the white patients become addicted. While this is not intentional, according to Dr. Andrew Kolodny, a director of opioid policy research at Brandeis University, in particular, African Americans are less likely to receive those prescriptions and therefore are less likely to become addicted. Unfortunately, this can make them more likely to endure unnecessary and excruciating pain for illnesses like cancer. Therefore, governmental enforcement of using more objective means to monitor pain could deter this unfair and potentially dangerous bias.
To properly address the underlying racial bias and accessibility aspect to this issue, medical professionals should have cultural bias training. As studies have shown, some healthcare professionals underestimate the pain of Black patients in comparison to white patients as result of ethnic biases. Therefore, their pain often goes undiagnosed and undermined; the mortality rate of low-income white communities may be unintentionally higher than other communities. Acknowledging this bias may encourage medical professionals to treat their patients equally regardless of race and minimize the bias in receptivity towards pain as well as decrease the bias in opioid prescriptions. Sensitivity training as a solution is practical and feasible, as it can be a portion of a healthcare professional’s education prior to beginning work.
Moreover, we must rectify current and past harms of U.S. drug policies. By decriminalizing personal possession of drugs as well as expunging the arrest records of the many (mostly young men of color) who were caught up in punitive drug policies, the United States government will be taking steps in the right direction. In addition, proactive policies from legislators prior to voting on legislation must be discussed; legislators must ask questions and evaluate criminal justice reforms could affect racial disparities before voting on policies. With this in mind, legislators themselves can prevent this systematic racism from continuing on in the healthcare field. Overall, unless we scrutinize narcotics policies for their racial targeting and continue the underlying racial biases in the healthcare field, these inequalities in healthcare will continue. As we have seen, this has and will continue to make white individuals much more vulnerable in the opioid crisis. Therefore, in the face of inadequate attention to this public health crisis, change must happen.