Across California, a blessing has become a curse for patients who dwell in overwhelmingly white communities: their ready access to opioid pain relievers.
A new study of prescribing practices across all of California's 1,760 ZIP codes helps explain why opiates, some of medicine's most addictive drugs, have wreaked more havoc on white communities than on communities of color.
The answer, at least in part, appears to lie in unconscious physician biases about race, ethnicity and pain that more typically leave minority patients underserved and undermedicated, authors of the new study said.
The resulting disparity in care may have briefly shielded minority communities from harm, said study leader Joseph Friedman, a medical student at UCLA. But for far longer and in many more instances, he said, "systematic racism within the health care system has led to ... insufficient treatment" of minority patients' physical and psychic pain.
The findings from California were published Monday in the journal JAMA Internal Medicine. They appeared alongside a report chronicling the changing racial mix of opioid fatalities in New York City and an analysis from the Centers for Disease Control and Prevention showing that while doctors cut their rate of opioid prescribing by 20 percent between 2015 and 2017, current levels remain almost three times higher than they were in 1999.
The California study reveals that, between 2011 and 2015, residents of neighborhoods with the highest proportions of white people were more than twice as likely to be prescribed an opioid pain reliever than were residents of neighborhoods where whites were most scarce.
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In ZIP codes dominated by whites who were not of Latino or Asian heritage, opioid prescriptions flowed freely during the study period. And they were by far most generously offered in low-income white communities.
However, in ZIP codes with the highest proportion of minority residents, not even high income levels could close a yawning race and ethnicity gap in opioid prescribing.
The result is now all too familiar: an epidemic that has cut a swath of death and destruction through poor, rural white communities while largely sparing minorities.
(That has begun to change in recent years as the opioid street drugs heroin and fentanyl have become cheaper and more widely available, ensnaring more minority users. Between 2016 and 2017, the biggest increase in opioid-related drug overdose deaths -- 56 percent -- was seen among African Americans, according to the CDC.)