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By an overwhelming margin (almost 75%), Black patients were more likely to be prescribed oral opioids in combination with intravenous (IV) opioids compared to white patients, despite the known risks of opioid addiction, according to research presented Oct. 18 at the Anesthesiology 2024 annual meeting in Philadelphia.
Black patients also are about 30% less likely than their white counterparts to receive multimodal analgesia, which uses various medications to improve pain control while reducing opioid use. Experts note that this approach has been particularly effective after complex surgeries, such as lung or abdominal cancer procedures and hernia repairs.
"We know that multimodal analgesia provides more effective pain management with less need for opioids, which are highly addictive. It should be standard practice, especially in high-risk surgical patients," said Dr. Niloufar Masoudi, lead author of the study and an anesthesiologist at Johns Hopkins University.
The study examined the pain management of 2,460 white patients and 482 Black patients during the first 24 hours following high-risk surgeries between 2016 and 2021. Researchers ruled out variables such as insurance, health conditions, and age -- identifying significant racial disparities in pain treatment. While most patients received IV opioids, Black patients were significantly more likely to receive additional oral opioids.
"Pain specialists need to understand the benefits of multimodal analgesia, recognize the existence of disparities in its use, and develop standardized protocols to ensure all patients receive this preferred form of pain management when medically appropriate," Dr. Masoudi said.
As the medical community continues to address these disparities and challenges, she stressed: "We must do more to ensure equitable treatment for all patients. Every patient deserves the highest standard of care, regardless of race."
Combating disparities
The Department of Health and Human Services established a task force on Black and minority health in 1983 -- the first time the U.S. government formed a group of experts to conduct a comprehensive study on the impact of race on health care. In 1985, release of the "Report of the Secretary's Task Force on Black and Minority Health" significantly raised awareness of racial disparities within the industry.
Extensive reports like the Harvard Medical Practice Study followed, documenting a connection between substandard care and healthcare centers treating substantial numbers of poor and racially marginalized patients.
Despite decades of recognition and documentation of health disparities, many persist and, in some cases, have widened. Analysis across a broad range of measures finds that Black Americans remain far worse off than their white counterparts across half or more of the measures, including infant mortality, pregnancy-related mortality, diabetes mortality, and cancer mortality.
According to KFF, an independent health policy research organization, Black people register higher uninsured rates and worse health status. They also are more likely to go without care due to cost.
Among KFF's findings: Black life expectancy is nearly five years shorter than white life expectancy; Black infants are more than twice as likely to die than white infants; and Black women are nearly three times more likely than white women to die from pregnancy-related causes.
Minnesota launches office
The Minnesota Department of Health launched the Office of African American Health earlier this year to combat racial disparities in healthcare.
The office focuses on identifying and addressing health disparities affecting Black communities "stemming from historical and cumulative discrimination and disadvantages across various sectors such as housing, education, employment and health care."
The office promotes health in Black communities through partnerships, targeted initiatives, and policy and strategic change efforts.
Legislation authorizing the office passed in 2023. It also established the African American Health State Advisory Council and the African American Health Special Emphasis Grants for community-based organizations to plan and develop programs to improve Black health outcomes. Passage of the law followed a 2021 Minnesota Health Access Survey, which found that 39% of Black Minnesotans reported unfair treatment by healthcare providers.