Study: Nonwhite areas less likely to have opioids
More than 50% of New York City pharmacies do not have adequate medication in stock to treat people in severe pain, a study reported in the April 6 New England Journal of Medicine.
New York researchers surveyed pharmacies throughout the five boroughs of New York City to examine the availability of commonly prescribed opioids in the city’s pharmacies. They discovered that pharmacies in predominantly nonwhite neighborhoods are significantly less likely to stock opioids than pharmacies in predominantly white neighborhoods. Two-thirds of pharmacies that did not carry any opioids were in neighborhoods where the majority of the residents were nonwhites, according to the study.
"Previous research has shown that members of racial and ethnic minority groups are at substantial risk for the undertreatment of pain," said R. Sean Morrison, MD, lead author of the study and assistant professor at The Lilian and Benjamin Hertzberg Palliative Care Institute of the department of geriatrics and adult development at Mount Sinai School of Medicine in New York City.
"Our research identifies a barrier to treating the pain of these groups effectively. When patients are prescribed opioid analgesics by their physicians but do not have access to these pain medications at their neighborhood pharmacies, they are needlessly suffering," says Morrison.
Pharmacies are ill-prepared
Of the 347 pharmacies in the five boroughs — 81% of all pharmacies contacted — that responded:
• 176 (51%) did not have opioid supplies that were sufficient to provide adequate treatment for a patient with severe pain.
• 54 (16%) had no opioids in stock.
• Although 116 (95%) of the pharmacies with incomplete supplies had a combination of products in stock that could be used for the treatment of moderate pain, only 55 (45%) carried a strong opioid preparation that could be used for the treatment of severe pain.
According to surveyed pharmacists, the three major reasons for not having adequate supplies of opioids were:
• regulation with regard to disposal, illicit use, and fraud;
• low demand;
• fear of theft.
Other reasons pharmacists gave included:
• additional paperwork required by state and federal drug-enforcement agencies;
• regulatory oversight and monitoring of those medications;
• fear of penalties imposed by state and federal agencies.
Pharmacists who reported a low demand for opioids or expressed concern about their disposal were most likely to be in predominantly nonwhite neighborhoods.
"The movement to educate health care professionals on providing appropriate pain and palliative care for patients has made tremendous strides over the past few years," said Morrison. "However, our efforts are thwarted when access to and availability of the services and therapies we prescribe are denied."
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