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Low-income Whites At Highest Risk for Opioid Addiction, Overdose

— February 21, 2019

New research suggests that the population at the highest risk of opioid addiction and overdose is low-income whites who have received prescription pills.

New research shows that of all the racial and ethnic groups across the United States, low-income whites are more likely to receive opioid prescriptions and to die from overdoses.  Of all of the populations, low-income whites receiving prescriptons were also most likely to become addicted.

“We propose that the prescription drug crisis should be thought of as a ‘double-sided’ epidemic, in which systematic racism within the healthcare system has led to increased addiction and overdoses among low-income white areas, but also insufficient treatment among nonwhite communities,” Joseph Friedman from David Geffen School of Medicine, UCLA, Los Angeles, California said, adding, “These disparities may have ironically shielded communities of color from the brunt of the opioid epidemic.   Nevertheless, they also represent a lack of access to adequate treatment for pain and psychiatric conditions.”

The ethnicity-income factor was analyzed among those given an opioid prescription in California, using the percentage of individuals who received at least one prescription for an opioid each year.  From 2011 to 2015, 23.6% of all individuals in California fifteen years of age or older received such a prescription, according to the February 11th JAMA Internal Medicine report, and the mean annual prevalence of opioid prescriptions was highest among individuals in the highest proportion-white/lowest-income quintile (44.2%) and lowest in the lowest proportion-white/highest-income quintile (16.1%).  What’s more, there were 9.6 opioid overdose deaths in California each year per 100,000 people in the highest proportion-white/lowest-income quintile versus 1.3 in the lowest proportion-white/highest-income quintile.  Thus, overall the population at the highest risk of addiction and overdose overall was low-income whites.

Low-income Whites At Highest Risk for Opioid Addiction, Overdose
Photo by Nik MacMillan on Unsplash

“Discussions of race are remarkably absent from mainstream medical and political discussions of the opioid epidemic,” Friedman said. “We highlight systematic and profound racial disparities in the prescription of controlled substances, showing that race must be considered as a key dimension in discussion of controlled substances in the United States.”

Dr. Mathew Kiang from Stanford University School of Medicine’s Center for Population Health Sciences, Palo Alto, California, said, “Opioids are an important part of the physicians’ toolbox.  They’re a powerful method of controlling a patient’s pain level; however, they are also potentially dangerous to a small set of recipients.  While this is an ecological study, as the authors note, and thus cannot determine if those who received opioid prescriptions were also those who subsequently overdosed on heroin, it still serves as a reminder that this powerful tool must be used carefully.”

“I think this highlights a growing body of work that continues to put the opioid epidemic in the context of socioeconomic factors,” he continued. “Race/ethnicity and income are important social determinants of health and our policies to address the epidemic thus far have largely ignored them.  We need to take into account the social and economic context of the epidemic in order to understand what is driving a subset of the population to using opioids for non-medical purposes.”

Dr. Barry Meisenberg, Chair of Medicine and Medical Director of the DeCesaris Cancer Institute at the Anne Arundel Medical Center, Annapolis, Maryland, added, “The results showing differential prescribing by micro regions for all three drug classes are profound and raise additional questions.  We don’t know if these results are explained by prescriber bias, differences in access, or increased patient demand in affluent areas or all three.  Certain symptoms such as anxiety, pain and distraction may have different interpretations and meaning in different cultural subgroups creating different interest in receiving certain medications.”

“This study adds to the body of evidence that clinician prescribing patterns are important drivers of long-term opioid dependence and overdose,” he continued. “Clinicians must understand that their prescriptions can affect the health of entire communities.  We have an individual and group responsibility to be cautious in our use of all of these medications.”


Opioid Prescriptions, Overdose Deaths Most Common Among Low-Income Whites

In California, opioids most often prescribed in low-income, mostly white areas

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