Surgeon General Jerome Adams, M.D., called on physicians Monday morning to re-evaluate their prescribing habits and take a more proactive role in helping patients struggling with opioid use disorder (OUD).
His plea comes amid new evidence about the ways prescription rates affect certain populations released in the Journal of the American Medical Association (JAMA) on Monday. JAMA released four articles Monday that underscored ethnic and income disparities in opioid prescribing rates.
These differences are mirrored in increased overdose deaths among white, low-income communities, leading to renewed questions about prescribers' role in the crisis.
Adams, and Assistant HHS Secretary Brett Giroir, M.D., discussed several ways doctors can rethink that role in an invited commentary published alongside the JAMA articles.
"Healthcare professionals can promote evidence-based nonopioid, and even nonpharmaceutical, treatments for pain. They can screen their patients for OUD and OUD risks, such as trauma and adverse childhood experiences. They can refer patients with OUD to receive medication-assisted treatment or, preferably, become medication-assisted treatment prescribers themselves," Adams and Giroir wrote in the commentary.
Since opioid prescription rates are so high in low-income, white communities, Adams and Giroir asked physicians to think critically about the way they treat patients from those communities. "Healthcare professionals can also support a patient’s overall recovery efforts with the knowledge that the disease of addiction is treatable, but treatment does not end abruptly with detoxification or the completion of a 30-day rehabilitation program," they said.
Two trends are simultaneously leading to this racial/economic disparity, researchers wrote in one of the JAMA articles. First, physicians may be more attuned to addiction considerations in their wealthier patients, they wrote, and those patients have funds for alternative treatment methods.
Secondly, doctors are statistically less likely to prescribe pain medication to minority patients—a blessing and a curse in the current climate of high pain and addiction. Several studies have shown that healthcare professionals underestimate the pain of black patients, the researchers wrote, leading them to systemically undertreat those patients.
"In light of a similar gradient in opioid overdose deaths, these disparities in opioid prescription may have played an accidental protective role in minimizing the opioid epidemic among minority communities. Nevertheless, they also represent the undertreatment of the legitimate medical needs of patients of color and remain an important inequity to be ameliorated," the researchers wrote.