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Determining Who Gets Pain Drugs is More than a Question of Pain

Researchers say not everyone visiting the doctor complaining of pain is equally likely to get opioids—pain relievers that are highly effective, but potentially habit-forming.

Get hurt running from the police? That may reduce your chances of getting a prescription, compared with someone injured while attending a symphony, says Case Western Reserve University sociologist Susan Hinze, PhD, who described the potential for discrepancies in the journal Research in the Sociology of Health Care.

Josh Tamayo-Sarver, MD, PhD, an emergency physician and two-time Case Western Reserve graduate, contributed to the research, which said, essentially, that social factors—not just medical ones—may sway doctors' prescribing practices.

Researchers asked emergency room doctors how likely they would be to prescribe opioids for an ankle fracture, back pain or migraine headache, based on different patient scenarios. The nearly 400 responses pointed to various biases, Hinze says.

Doctors were more likely to prescribe opioids if the patient was injured in a "socially acceptable" way—while playing intramural college basketball, for example—and had a regular primary care provider. Some strikes against a patient, in doctors' eyes: a history of frequent visits to the ER, tattoos or body piercings and being unemployed.

The bottom line: Factors indicating higher social class helped, while those indicating lower social class hurt.

"Our analysis suggested that doctors were concerned about 'deservingness,' not only drug abuse potential," Hinze says, adding that she hopes the cycle of bias can be interrupted—and resulting disparities dissolved—by alerting physicians to their prescribing proclivities and increasing their training in pain and addiction.

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