Pharmacies in minority, low-income areas less likely to carry sufficient pain me

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Pharmacies in minority, low-income areas less likely to carry

sufficient pain medications, USA

http://www.medicalnewstoday.com/medicalnews.php?newsid=31838

Chronic pain is a condition that affects one in five Americans

without regard for their race or finances. But a new study finds that

minorities and people with low incomes have less access than high-

income white people to the medications that will help them endure

their pain.

In a wide-reaching study of 95 pharmacies in ZIP codes with

predominantly white populations and 93 pharmacies in ZIP codes with

predominantly minority populations, researchers at the University of

Michigan Health System's Department of Anesthesiology found a

pronounced gap in the availability of prescription opioid analgesic

medications.

The study, which appears in the new issue of the Journal of Pain,

found that Michigan pharmacies in predominantly minority areas were

significantly less likely to have sufficient supplies of prescription

opioid analgesic medications - drugs that include oxycodone, morphine

and methadone - when compared with predominantly white areas.

In addition, the odds of not having sufficient supplies of opioid

analgesics - also known as narcotics - are significantly higher among

pharmacies in low-income areas compared with high-income areas,

regardless of the racial makeup in the vicinity.

" The key finding is that there are differences in the ability to

obtain pain medications in local pharmacies, with the lowest

availability in minority and low-income areas, " says lead author

Carmen R. Green, M.D., associate professor in the U-M Health System's

Department of Anesthesiology and pain specialist at U-M's Center for

Interventional Pain Medicine. " The result of this disparity is that

vulnerable populations are at increased risk for insufficient and

lesser-quality pain care.

" For the pharmacies located in higher-income ZIP codes, those in

white ZIP codes were more than 13 times more likely to have

sufficient supplies than those in minority ZIP codes. When looking at

those in lower-income ZIP codes, those in white ZIP codes were 54

times more likely than pharmacies in minority ZIP codes to have

sufficient supplies. "

The statistics gathered during the U-M study corroborate something

Green knows from her patients' experiences. " I have patients who have

to drive 30 miles or more just to get their pain medications, " Green

says.

Most of the pharmacies met the study's criteria for having sufficient

opioid supply, which meant they had at least one drug in each of

three categories: controlled release (such as controlled release

oxycodone, controlled release morphine, fentanyl and levorphanol);

short acting (such as immediate release oxycodone, immediate release

morphine and hydromorphone); and combination products (such as

acetaminophen and hydrocodone, aspirin and oxycodone, and

acetaminophen and codeine).

But when comparing the number of pharmacies in white ZIP codes and

minority ZIP codes that frequently stocked sufficient supplies of the

medications, the gap was pronounced: 86.9 percent in white ZIP codes

versus 54.2 percent in minority ZIP codes.

When asked about the insufficient supplies of these medications, the

most common reason cited by pharmacists participating in the study in

both white and minority areas was low demand (93.1 percent), which

did not differ by racial composition or income. Green notes that the

study did not delve into what " low demand " means, and she says future

studies would be needed to shed light on this issue. The fear that

patients might use opioid analgesics for illicit purposes was the

second most common reason (8.5 percent), followed by too much

paperwork and fear of robbery (about 1 percent each).

To the authors' surprise, the study found that non-corporate

pharmacies were more 24 times more likely to carry sufficient

supplies of the medications than corporate pharmacies. Researchers

also found that having a hospital near the pharmacy did not affect

the availability of opioid analgesics.

Green believes that the new findings have important public health

implications since people living in predominantly minority areas

faced significant barriers to accessing pain medication, with greater

disparities in low-income areas regardless of racial composition.

Beyond minorities, these findings are particularly important for low-

income people regardless of race, she notes.

The data are from pharmacies across the state of Michigan that were

contacted between June 2003 and April 2004. Further studies will be

needed to determine if the findings are true of the rest of the

country.

In addition to Green, authors on the paper are S. Khady Ndao-

Brumblay, M.Sc., Pharm.D., senior research associate in the

Department of Anesthesiology; Brady West, M.A., senior statistician

and statistical consultant with the Center for Statistical

Consultation and Research, Office of the Vice President for Research

at U-M; and Tamika Washington, research assistant, of the Department

of Anesthesiology.

Funding was provided by the U-M Health System's Department of

Anesthesiology. Reference: Journal of Pain, vol. 6, issue 10, Oct.

2005.

University of Michigan Health System

med.umich.edu/prmc/media/relarch.cfm