How Racism Ensures That Chronically Ill Black Kids Receive Poor Pain Management
Racism isn’t “saving” black people from the opioid crisis. It is only ensuring that the chronically ill black kids receive the worst pain management possible.
The current opioid epidemic is being called many things on the internet and in the media. The term that stands out is “the gentler war on drugs.” The name stems from the “war on drugs” of the 80s and 90s which saw the criminalization of crack addiction and the incarceration of hundreds of thousands of people addicted to or selling the drug.
Today’s opiate addiction wave is happening outside the urban communities, originating in doctor’s offices, and inundating the suburbs with heroin and opioid-based pills that carry an addiction that is much worse than crack to overcome. The fact that it’s even called an epidemic is problematic.
The opioid addiction situation has led to several programs to benefit addicts, such as needle exchanges, Naloxone-carrying first-responders, and programs where addicts can come to the police station with the drugs and leave in a car ride to rehab—no criminal charges filed.
The gentler drug war is not, however, benefiting everyone. According to Dr. Elissa Miller, Director of Palliative Care at Nemours Hospital in Delaware, the new restrictions on opioid prescriptions don’t involve criminal charges, but they do end up criminalizing the children who need the medication the most—young sickle cell patients in chronic pain. She says that these are the kids from families who are already wary of the medical establishment and are already struggling to maintain the outpatient care for the sick child in the family.
The restrictions that Dr. Miller is forced to perform now drive a deeper wedge between her and her patients, while also making yet another barrier to care that the families must overcome in order to find care for the sick child.
It’s no secret that black children are already the group of patients who receive the least pain management, according to articles like Rachel Rabkin Peachman’s “Why aren’t We Managing Children’s Pain?” which looks at the many ways kids are under-prescribed opioid painkillers when those are the very pain relief the child needs. Peachman says,” data shows that adults with the same underlying condition will get two to three times as many pain medication doses as children.” The inequality in pain management is worse with younger patients.
In addition to being denied full care because they are kids, sickle cell patients are black and latinx kids—kids of color who have been proven to be further denied proper care because of their race. A Journal of American Medical Association study entitled, “Trends in Opioid Prescribing by Race/Ethnicity” states that patients who enter the emergency room with the same reported level of pain were not treated with the same care over a 12-year study. “Over the years, white patients with pain were more likely to receive an opioid (31%) than black (23%), Hispanic (24%), or Asian/other patients (28%), and the differences did not diminish over time,” as the rate of prescribing opiates exploded.
These studies and the knowledge that black kids receive the brunt of pain management care is actually common knowledge among medical professionals and families with chronically ill children. Hence some of the mistrust between the black families and the white doctor trying to treat their sickle cell patient’s pain.
Actually, this information is not even news to the media reporting on the opioid epidemic and also the people legislating it. Some major news outlets even had jokes about the fact that blacks were “left out” or “saved” from the opioid epidemic because racist medical practices left them undermedicated.
A white reporter for New York Magazine even actually mocked the situation with her headline on the opioid epidemic “Is Racism Saving Black People from Opioid Overdoses”. No, racism isn’t “saving” black people from anything. It is only ensuring that the chronically ill black kids receive the worst pain management possible.
That leads us back to Dr. Miller and the opioid restrictions enacted earlier this year. According to Delaware’s press release on the restrictions, even the children receiving palliative care must submit to the conditions laid out in the new policy designed to prevent overdose and addiction. This means reducing monthly prescriptions down to seven days, which requires the families to drag their sick child into the doctor’s office weekly for medication. Some patients are allowed longer prescriptions, under special circumstances.
At every appointment, patients must submit to an intimate questionnaire about their drug habits (in the kids’ case, their medication routines) and be questioned about the possible misuse of medications and use of other restricted drugs. After the questionnaire, the children must undergo drug testing—meaning these little kids must pee in a cup under supervision and have it tested before receiving their pain relief for the week.
These and the other elements of the new restrictions are similar to another process—that of an ex-convict exiting prison and being paroled into public life. These ex-prisoners are subjected to weekly or periodic meetings with the parole officer where they come into the office, submit to an intimate questionnaire about their drug habits and undergo a drug test to prove they are staying clean and out of trouble. The difference between a parolee and a sickle cell patient is that the parolee has an exit date on this process—a date when the probing and questioning ends. For the kids, it goes on for the rest of their lives. Kids like those under Dr. Miller’s care will never get free of sickle cell pain.
Delaware was just one of about 17 states that enacted these restrictions in 2017. Other states are developing similar policies. Dr. Miller fears that criminalizing the children and their families as they seek relief from the chronic pain creates a huge barrier to care for a population that is already underserved and neglected by the medical community.
Another barrier manifests if she does find a discrepancy in the opiates she prescribes the child and the amount of the drugs in the child’s urine. She is forced to call in the Delaware Department of Services for Children, Youth, and Their Families to investigate why the child had too much or too little of the opiates in their system. The fear of having to face social workers if mom and dad couldn’t fill the prescription that week would force a family to skip the vital care that their child needs.
The new laws are supposed to be a gentle way of easing the white suburban population off its addiction to opioid pills and heroin. What the policy actually accomplishes is the further disenfranchisement of chronically ill black and latinx children. These same children are already the ones receiving the worst care in the area of pain management. They are also living with a condition that is rare and exclusive to people of color, two factors to keep sickle cell patients dependent on opiates for pain relief, as the innovation in pain management and disease treatment go to more “popular” conditions like breast cancer. Meanwhile, the sickle kids continue to be treated like criminals in order to get their pain relief and summarily forgotten as this “gentler war on drugs” wages on.
You can help sickle patients by donating blood to the American Red Cross (you can ask to have the blood tagged for sickle cell patients) or volunteer your blood marrow for a blood marrow transplant. You can also donate your cash to sickle cell research in order to get closer to having opiate-free pain medication for sickle cell patients.
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