(CN) — While drug epidemics in the United States tend to affect non-whites, the opioid crisis in America has targeted largely low-income white populations, according to a new study released Monday by the American Medical Association.
Published in the Journal of the American Medical Association, the study found a 300 percent difference in the racial disparities among people who consume opioids in California. The study authors, using prescription drug data, researched records of 29.7 million people in California who received a prescription opioid from 2011 to 2015.
The authors also looked at the prevalence of stimulant prescriptions in the study area, which included 1,760 zip codes in California.
The study showed that 44.2 percent of adults in the zip codes with the lowest-income and highest proportion of white population received at least one opioid prescription per year. That compared to 16.1 percent of people in the highest income/lowest proportion white population who received an opioid prescription.
“These discrepancies may have shielded non-white communities from the brunt of the prescription opioid epidemic but also represent disparities in treatment and access to all medications,” the study said. Across drug categories, controlled medications were much more likely to be prescribed to individuals living in majority-white areas, according to the study.
“The concentration of this epidemic in a racial/ethnic majority group is epidemiologically noteworthy, and it speaks to the unique social context of the current opioid crisis,” the study said.
The opioid epidemic killed more than 42,000 people in the United States in 2016 — more than any previous year on record. Roughly 40 percent of opioid overdose deaths involve a prescription opioid, according to the U.S. Department of Health and Human Services.
The epidemic has been described as a “disease of despair” and is linked to poverty and lack of economic opportunity among increasingly downward mobile sectors of working class America, Monday’s study said. The Department of Health and Human Services in 2017 declared a public health emergency over opioids.
There were 9,534 reported opioid overdose deaths in California from 2011 to 2015, according to the study, and overdose deaths were highly concentrated in lower-income and mostly white areas, revealing an approximate 10-fold difference in overdose rates across the race/ethnicity–income gradient in California.
The overdose deaths included overdoses from any opioid, including prescription medication, heroin and synthetic opioids like fentanyl.
The opioid crisis reveals how different racial groups have access to healthcare.
According to researchers in this study, healthcare professionals are more likely to prescribe opioids to white patients than to racial or ethnic minority patients who have the same medical symptoms.
Researchers said Hispanic patients were half as likely to receive analgesics following major bone fractures than white patients, and similar discrepancies in pain medication prescribing were found for black patients.
“Recent studies have found that health care professionals often underestimate the pain of black patients when compared with white patients,” the study said.
The opioid crisis has also affected the rise in heroin use.
According to the JAMA study published Monday, the majority of individuals who are dependent on heroin reported using a prescription medication as their first opioid of abuse, which suggests that healthcare professionals played an important role in the recent surge of addiction and related overdoses.
“This link between the health care system and opioid addiction may provide an explanation for the observed racial/ethnic differences in the outcomes of the opioid epidemic,” the study said.
The JAMA study also showed vast discrepancies in prescription rates for stimulants in the greater Los Angeles area.
Comparing stimulant prescriptions in zip codes from Malibu and Beverly Hills to south central Los Angeles, these areas of higher-income, mostly white areas showed ”markedly elevated” rates of stimulant prescription prevalence, the study said.
Prescriptions for stimulants, such as benzodiazepine, were highly concentrated in mostly white, high-income areas, with 15.7 percent of adults in the areas with the highest proportion white population receiving at least one prescription each year, compared with 7 percent among the lowest proportion white population.
In and around Beverly Hills, roughly one of every four adults received a benzodiazepine prescription during the study period. In the low-income, inner city neighborhoods of Compton and Watts, that figure was one in 20 adults.
The study of California prescription data showed that prescription rates for the stimulant benzodiazepine were highest in the demographic of male adolescents ages 10 to 14 years old, suggesting that the largest contribution of stimulant prescriptions is for the treatment of attention-deficit/hyperactivity disorder.
The opioid crisis in America was fueled in large part by marketing of opioids by pharmaceutical companies, according to lawsuits targeting Purdue Pharma, the maker of OxyContin, a synthetic opioid painkiller.
The annual number of prescriptions for OxyContin increased from 670,000 to 6.2 million between 1997 and 2002, and the total number of opioid prescriptions increased by 45 million, according to the Mayo Clinic.
A federal court in 2007 found Purdue Pharma provided false information about the addiction potential of OxyContin and fined the company $634.5 million.
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