Pubdate: Sun, 16 Oct 2005
Source: Tampa Tribune (FL)
Copyright: 2005, The Tribune Co.
Contact:  http://www.tampatrib.com/
Details: http://www.mapinc.org/media/446
Note: Limit LTEs to 150 words
Author: Marc Kaufman, The Washington Post

PAINKILLERS SCARCE AT PHARMACIES IN BLACK COMMUNITIES

WASHINGTON - -- 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 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 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." Crime
Concerns

The study found that one possible nonclinical 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 Washington 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 windows indicating that.

Pain diagnoses are notoriously difficult to make because there is no
objective way to measure suffering. Heavy-Handed Oversight

Research during the 1990s led many pain doctors to conclude that
prescription narcotics such as OxyContin could be used at higher
strength without a high risk of addiction. But the Drug Enforcement
Administration became 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 doctors and
pharmacists for alleged improper and illegal prescribing, and a number
are serving lengthy jail terms.

Two high-profile cases involved pain doctor William E. Hurwitz of
McLean, Va., and pharmacist Emmanuel Thad Ereme, who operated Hremt
Pharmacy in District Heights, Md. Both said they were trying to help
patients, 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 reportedly has been most widespread
in rural white areas, she said pharmacists everywhere have become
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
also are 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 although the DEA tracks and monitors the sale of
controlled drugs, it does not mandate how much of a medication a
pharmacy should carry. 
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