Implicit biases in doctor’s offices and elsewhere in health care are likely drivers behind stark racial and class divides in drug addiction and overdose deaths in California, a new study suggests.
While affecting people across race and ethnicity, the opioid crisis gripping the nation has been concentrated largely among low-income whites, and has been labeled a problem primarily of public health, not of criminal justice. The epidemic is thought to have been touched off by a combination of social factors – including trauma, poverty and a lack of economic opportunity – and the widespread availability of prescription opioids beginning in the 1990s.
The new study, published in JAMA Internal Medicine, indicates the health care field has had a hand in driving the epidemic that goes beyond merely dispensing prescription drugs, suggesting that differing access to and within the system has resulted in rampant addiction among low-income whites as well as a sea of untreated pain in minority communities.
“The prescription drug crisis should really be thought of as a double-sided epidemic,” says Joseph Friedman, the study’s lead author and a medical student at the David Geffen School of Medicine at UCLA. “Essentially, the systematic racism within the health care system has led to increased addiction and overdoses in low-income white areas, but also, (to) insufficient treatment among communities of color.”
For example, in the poorest and whitest ZIP code areas in California analyzed by researchers, 44.2 percent of adults – defined as those 15 and older – received at least one opioid prescription per year on average, compared with 16.1 percent of adults in the richest, most racially diverse areas and 23.6 percent of adults across the state. In the state’s lowest-income, most racially diverse areas, meanwhile, 20.3 percent of adults were prescribed at least one opioid.
Stimulant prescriptions, meanwhile, were concentrated in mostly white, high-income areas, while benzodiazepines – medications that can be prescribed for anxiety such as Xanax, Valium and Diastat – were more prevalent in whiter areas, but did not significantly differ by income level.
The findings suggest race and class can outweigh a patient’s medical needs in determining who has access to prescription drugs, with consequences both “protective” and harmful, Schriger says. While the study notes that only a small fraction of prescriptions in a community represent an addiction or dependence, opioid overdose death rates in California have tended to be highest among low-income white communities that also have higher prescription rates.
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