I'd like to agree, but according to the abstract: "Differential prescribing by race/ethnicity was evident for all types of pain visits, was more pronounced with increasing pain severity, and was detectable for long-bone fracture and nephrolithiasis as well as among children."
The abstract simply doesn't address other possible categorizations of the patients besides race/ethnicity, probably because the full article doesn't either. It's also muddling the difference between "receive an opioid" and "receive a prescription for an opioid". In an ER situation, opioids are often not prescribed immediately, since masking the pain can sometimes hamper efforts to identify the cause (not the case with a clearly broken/injured limb, but definitely true for many cases of abdominal and thoracic pain). So at least a certain percentage of these cases are a question of whether or not a prescription was given to a patient being discharged, for home use. And how did they count patients who were given a dose of an opioid at the hospital, but not given a take-home opioid prescription?
It's not wrong for a doctor's knowledge or reasonable perception of a patient's, or child patient's parent's, history of drug abuse to influence this decision. This is a separate issue from race/ethnicity, but is likely to correlate statistically with race/ethnicity and could well account for the results this study is reporting. A meaningful study would need to address whether drug abuse history, rather than race/ethnicity was the real differentiating factor, or whether doctors might be erroneously assuming a drug abuse history more often with non-whites. There's no point writing a take-home prescription for opioids for a child with a bone break or kidney stones, if the drugs are simply going to be consumed or sold by the parent, with the child not getting any. And there's often no benefit to writing a narcotics prescription for someone who has had a past narcotics abuse habit and is in danger of relapse -- the potential harm of triggering a relapse may be greater than the benefit of greater short-term pain relief from opioids vs some milder type of pain killer.
The abstract simply doesn't address other possible categorizations of the patients besides race/ethnicity, probably because the full article doesn't either. It's also muddling the difference between "receive an opioid" and "receive a prescription for an opioid". In an ER situation, opioids are often not prescribed immediately, since masking the pain can sometimes hamper efforts to identify the cause (not the case with a clearly broken/injured limb, but definitely true for many cases of abdominal and thoracic pain). So at least a certain percentage of these cases are a question of whether or not a prescription was given to a patient being discharged, for home use. And how did they count patients who were given a dose of an opioid at the hospital, but not given a take-home opioid prescription?
It's not wrong for a doctor's knowledge or reasonable perception of a patient's, or child patient's parent's, history of drug abuse to influence this decision. This is a separate issue from race/ethnicity, but is likely to correlate statistically with race/ethnicity and could well account for the results this study is reporting. A meaningful study would need to address whether drug abuse history, rather than race/ethnicity was the real differentiating factor, or whether doctors might be erroneously assuming a drug abuse history more often with non-whites. There's no point writing a take-home prescription for opioids for a child with a bone break or kidney stones, if the drugs are simply going to be consumed or sold by the parent, with the child not getting any. And there's often no benefit to writing a narcotics prescription for someone who has had a past narcotics abuse habit and is in danger of relapse -- the potential harm of triggering a relapse may be greater than the benefit of greater short-term pain relief from opioids vs some milder type of pain killer.