Painkillers Understocked in Minority Areas, Study Says
Says

By Marc Kaufman
Washington Post Staff Writer
Friday, October 14, 2005; A04



Pharmacies in black neighborhoods are much less likely to carry sufficient
supplies of popular opioid painkillers than those in white neighborhoods, a
new study has found, leading researchers to conclude that minorities are
routinely undertreated for chronic pain.

The study found that the disparity between what is available to patients in
majority-black neighborhoods compared with majority-white areas had little to
do with income levels, as pharmacies in wealthy black neighborhoods were no
more likely to carry the prescription painkillers than those in poorer black
neighborhoods. In wealthy white neighborhoods, however, pharmacies were far
more likely to carry sufficient stock than in poor white communities.

"The pharmacies in minority areas generally say they stock limited amounts
of pain medication because the demand is not there," said Carmen R. Green, an
associate professor at the University of Michigan Medical School, who led the
research.

"But the low-demand barrier does not ring true for me," she said. "We know
that minorities are more at risk of suffering chronic pain, and maybe they
don't come to local pharmacies because they've come to expect they won't carry
the medicines they need."

Green and other researchers said that the new study, published this week in
the Journal of Pain, is consistent with earlier studies showing that doctors
were less likely to prescribe opioid painkillers to minorities than to whites.

"I'm shocked by these results," said Ashish K. Jha, an expert in health care
disparities at the Harvard School of Public Health.

"There is no plausible explanation that makes sense," he said. "It's hard to
know what gets us there, but if pharmacies are stocking [narcotic
painkillers] at substantially lower levels for black people, what is clear is
that
there's no good clinical reason for it."

The study found that one possible non-clinical explanation for the lower
availability is concern about illicit use, and the potential consequences for
the dispenser.

The head of the Washington D.C. Pharmaceutical Association and one Capitol
Hill pharmacist agreed with that assessment. Association President Herbert
Kwash said many pharmacists in the District are reluctant to carry controlled
drugs because of concerns that they will be robbed and their customers
endangered. For those reasons, said pharmacist Michael Kim of Grubbs Pharmacy
on East
Capitol Street, some druggists no longer carry prescription narcotics and
have signs in their front windows indicating that.

Pain diagnoses are notoriously difficult to make -- whether from an
accident, from chronic arthritis or back pain, or from cancer -- because there
is no
objective way to measure suffering.

Research during the 1990s led many pain doctors to conclude that
prescription narcotics such as OxyContin, Dilaudid and Percocet could be used
at higher
strength without a high risk of addiction. But the Drug Enforcement
Administration became increasingly concerned about the diversion of these
prescription
narcotics, which agency officials argued became overprescribed and widely
abused.

That view led the DEA and local authorities to prosecute scores of doctors
and pharmacists for alleged improper and illegal prescribing, and a number are
serving lengthy jail terms. Two high-profile cases involved local
practitioners -- pain doctor William E. Hurwitz of McLean and pharmacist
Emmanuel Thad
Ereme, who operated Hremt Pharmacy in District Heights. Both men said they
were just trying to help patients in pain, but juries concluded they were
involved in criminal conspiracies to distribute prescription narcotics.

Susan Winkler, vice president for policy for the American Pharmaceutical
Association, which represents pharmacists, said concern over DEA
"heavy-handedness" could play a role in the limited availability of controlled
pain drugs in
some minority-neighborhood pharmacies.

Although the abuse of painkillers has reportedly been most widespread in
rural white areas, she said pharmacists everywhere have become increasingly
concerned about the risks of selling the controlled drugs. Patient demand
determines which drugs a pharmacy stocks, Winkler said, but the paperwork and
DEA
oversight associated with the narcotic painkillers are also factors.

"For every violation, there is a substantial fine," she said. "And an
investigation of a pharmacist's practice, like for a physician, can send a real
chill throughout the health care practitioner community. . . . With the
controlled drugs, the pharmacist now has to determine whether a prescription is
legally valid and clinically appropriate, and that's a heavy burden."

Green's study, which surveyed 188 Michigan pharmacies, found stark
differences in how well drugstores were stocked with opioid painkillers. In Zip
codes
predominantly inhabited by whites, 87 percent of pharmacies were deemed to
have sufficient supplies; 54 percent met that standard in predominantly
minority Zip codes.

The research also found a substantial difference between large chain stores
and independents. Although 91 percent of independents were found to be well
supplied with the painkillers, only 59 percent of chain stores met the
criteria.

Valerie Stork, spokeswoman for the National Association of Chain Drug
Stores, said that although the DEA does track and monitor the sale of
controlled
drugs, the agency does not directly mandate how much of a medication a pharmacy
should carry.

"It is up to each individual pharmacy to decide the quantity of controlled
substances to stock," she said.




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