How racism in pain management endangers the lives of Black Americans

Racism in pain management has been around since the beginning of medical care, but thanks to the opioid crisis, it’s really ramped up in the last few years. It’s become so prevalent that now doctors are patting themselves on the back because they’re “saving” Black people from the opioid crisis by being racist.

Doctors racist beliefs affect pain treatment

It is 2021 and yet half of a sample of white medical students and residents believe that black people feel less pain than white people because their skin is thicker.¹ Because of this racist belief, the medical students were less likely to offer adequate pain treatment to Black people. Furthermore, compared to white patients, Black patients are much less likely to be provided pain medication, and if they do receive it they get a lower amount. For example, with patients at the ER with broken bones and reporting similar amounts of pain, 57% of Black patients received pain treatment versus 74% of white patients. This holds true even in children.¹ Black children regularly receive less pain treatment than white children. Doctors are torturing children because of their racial bias. 

Black children regularly receive less pain treatment than white children. Doctors are torturing children because of their racial bias. Click To Tweet

In the era of opioid hysteria, medical professionals’ biases are all magnified. If a doctor judges that a person can’t really feel pain, then they label the patient as an addict, and that label has a devastating effect on further treatment. Once you receive the label it’s almost impossible to remove. If you need pain treatment in the future, you’ll receive a Tylenol and be told to be grateful. This problem is so pronounced that some Black patients are being removed from hospitals for asking for treatment.

Having to play the “good patient” to get pain treatment

Most pain patients are forced into playing the “good patient” to receive treatment, but the deck is stacked higher against Black patients. The Good Patient™ involves:

• looking sick, but not too sick, because addicts look sick
• dressing nice enough to be taken seriously, and looking like you can pay, but not too nice
• if you know what medicine you need, you can’t say that because it’s drug-seeking behavior
• hinting around what medicine you need and buffing up the doctors’ ego a bit before you make any suggestions
• bringing a care plan from your regular doctor, but not acting like you don’t think the ER doctor is knowledgeable too
• not having your GP put pain medication on a care plan because that’s also drug-seeking behavior
• even if everyone knows your illness is painful, DO NOT ADDRESS IT. That’s drug-seeking behavior, don’t even mention the word pain

Racist doctors torture Black people and claim it’s for their own good

The whole opioid epidemic is a moral panic over white people overdosing on drugs. Meanwhile, addiction “experts” are patting themselves on the back over the racist denial of pain treatment “saving” Black people from addiction. Of course, none of these experts are acknowledging the crack epidemic, because that was a “Black problem,” but here they are now to save the day!

Because Black people can’t get pain treatment, they’re less likely to develop an addiction, lucky them. Of course, this ignores the fact that only 1% of people with chronic pain become addicted, but that statistic is easy to ignore.

The National Center for Health Statistics estimates that 14,000 Black American’s would have died if they were treated for their pain like white Americans were.² What they’re forgetting to study or even mention is how many Black people have died from lack of pain treatment stemming from racism. One of the researchers Matthew Kiang is quoted:

First, it’s a good example of how more medical care is not necessarily a good thing. Second, it’s an extremely rare case where racial biases actually protected the population being discriminated against.³

They seem to be claiming that doctors are protecting Black people by being racist and denying them healthcare. Black people are actually “lucky” that they needlessly physically suffered because of white people’s disgusting racist ideas? Yikes. Racism kills patients. 

 

The white savior narrative by PROP

In addressing Black people being “lucky” for racism Shoshana Aronowitz, a trained nurse, and family nurse practitioner said:

The biggest issue I think here is the narrative that there’s any sort of upshot to racism in health care. And I think specifically when we’re talking about opioid prescribing, first, this ignores how much damage racism in health care causes. But second, it really stigmatizes black Americans who do suffer from opioid use disorder. It’s almost like, ‘What’s your excuse⁴?”

Unfortunately, the white savior narrative is propagated by the media and self-described “experts” like Andrew Kolodny, the founder of PROP (Physicians for Responsible Opioid Prescribing). He’s a psychiatrist that hasn’t treated a single pain patient, declares everyone in pain is an addict, and he makes money off his addiction clinics by forcing patients onto Suboxone and Buprenorphine. Still, the media loves to quote him in articles about the opioid epidemic like he’s an actual expert. He pushes that narrative that doctors’ racial bias “saved” Black people from the opioid epidemic and that they should be grateful.

A while ago I read an article like this one about sickle cell anemia patients being denied pain treatment. It’s shocking to me that the pain community isn’t talking about this.  For those who don’t know, most of the 100,000 U.S. patients with sickle cell are Black and many medical professionals are not familiar with the disease. Only 20 % of General Practitioners say they feel comfortable treating sickle cell disease and thanks to the opioid hysteria patients can’t get pain medicine from a GP anyway. They have to go to the ER for treatment, however, on average sickle cell patients wait for 25% longer than other patients. The study concludes:

We found that SCD patients experience longer wait times to see a physician upon arrival to an ED than do other patient populations, even though the SCD patients tended to present in higher levels of pain and tended to be assigned higher priority triage ratings. The African-American race of SCD patients appears to account for much of the difference in wait times between SCD patients and a General Patient Sample.⁵

This means that people with sickle cell are dangerously undertreated and they’re suffering unnecessarily because of bias against their race. Death rates from sickle cell have risen 1% every year since 1979. Increasingly young patients are dying because their disease isn’t taken seriously by medical professionals.

Black patients with sickle cell anemia are dangerously undertreated and suffering because of bias against their race. Death rates from sickle cell have risen 1% every year since 1979. Click To Tweet

Why aren’t we hearing more about this?

I’m struggling to understand why we’re not hearing more about this problem, especially in the activist pain community. It’s surprising there isn’t more pushback over the “racist doctors saving Black people from themselves” articles. The pain community (including myself) needs to do some introspection on why we’re not advocating more for POC.

 

 

 

 

Sources

1. Hoffman, K., Trawalter, S., Axt, J., & Oliver, M. (2016, April 19). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Retrieved May 20, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/

2. Alexander, M., Kiang, M., & Barbieri, M. (2018, September). Trends in black and WHITE OPIOID mortality in the United States, 1979-2015. Retrieved May 20, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6072374/

3. Frakt, A., & Monkovic, T. (2019, November 25). A ‘rare case where racial biases’ protected African-Americans. Retrieved May 20, 2021, from https://www.nytimes.com/2019/11/25/upshot/opioid-epidemic-blacks.html

4. Mosley, T. (2020, January 15). Black Americans tend to live with UNMANAGED pain WHEN UNDER-PRESCRIBED opioids due to racial Bias, experts say. Retrieved May 20, 2021, from https://www.wbur.org/hereandnow/2020/01/15/black-americans-pain-opioids-racial-bias

5. The Impact of Race and Disease on Sickle Cell Patient Wait Times in the Emergency Department. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608692/