Pubdate: Thu, 06 Apr 2000
Source: New York Times (NY)
Copyright: 2000 The New York Times Company
Contact:  229 West 43rd Street, New York, NY 10036
Fax: (212) 556-3622
Author: Denise Grady


Cancer patients and others with severe pain who live
in black, Asian and Hispanic neighborhoods may have trouble getting
medicine for their pain, because their local pharmacies often do not
stock morphine and related drugs, doctors are reporting.

A survey of 347 pharmacies in New York City found that in nonwhite
neighborhoods, only 25 percent of pharmacies had enough morphine-like
drugs, or opioids, to treat severe pain. But in white neighborhoods,
72 percent of the stores had adequate supplies.

Although the survey was conducted in New York, interviews with
pharmacists and doctors in Los Angeles, Chicago, Minneapolis and
Detroit suggested similar problems in those cities.

Druggists who did not carry the medicines blamed low demand, onerous
regulations and fear of theft. But when the analysis of the numbers
was adjusted to take actual crime rates into account, opioid
availability was still linked to the racial makeup of the

Some doctors who reviewed the report suggested that the real culprit
was a subtle form of racial bias.

"This study comes on the heels of many other studies that have
documented a disparity in treatment in which racial and ethnic factors
seem to be the predominant factor, and that's quite disturbing," said
Dr. Richard Payne, chief of the pain and palliative care service at
Memorial Sloan Kettering Cancer Center. Dr. Payne did not take part in
the study, but wrote an editorial that is being published with it
today in The New England Journal of Medicine. The study itself was
directed by Dr. Sean Morrison of the Mount Sinai School of Medicine.

But others said racial bias was too simple an explanation.

Selig Corman, a pharmacist who is director of professional affairs for
the Pharmacists Society of the State of New York, in Albany, said the
lack of drugs in certain neighborhoods was more likely due to low
demand for them, because pharmacists cannot afford to stock drugs that
people do not buy. And in low-income areas, where people lack
insurance, sales may be slow.

The study did not determine why demand was low -- whether, for
example, patients had been turned down and had given up asking. But
Dr. Payne said that if the claim of low demand is true, it may be
another symptom of the larger problem, that pain is inadequately
treated in minority groups, in large part because doctors do not
prescribe enough medicine. Reasons that have been suggested for the
failure to prescribe include the false perception among some doctors
that blacks are less sensitive to pain than whites, or more likely to
be addicts.

Whatever the reason, the authors of the survey said it offered new
evidence that many blacks and Hispanics, including elderly people with
cancer, either do not receive proper treatment for severe pain, or
face obstacles and delays in obtaining it.

Doctors say the problem fits into a nationwide pattern of racial
inequality in health care, revealed by recent studies showing that
blacks are less likely than whites to be referred for kidney
transplants or surgery for early-stage cancers of the breast, colon or
lung, and that blacks and Hispanics are less likely to be given
painkillers for broken bones or pain following surgery.

Dr. Morrison, a specialist in geriatrics and palliative care at Mount
Sinai, said he and his colleagues began their study because they found
that many black and Hispanic patients could not have prescriptions
filled for opioids at their neighborhood pharmacies. Often,
pharmacists would not even offer to order the products, and when they
did, it could take several days or a week for the medicine to arrive.

"For severe pain, even a 24-hour delay is unacceptable," Dr. Morrison

Dr. Morrison described a 74-year-old Hispanic woman from the South
Bronx with severe back pain from a spinal disease, for whom he
prescribed morphine and a similar drug. When he called her the next
day, she was still in agony. Her daughter had gone to every pharmacy
in the area, but could not get either drug. Dr. Morrison helped the
daughter find a pharmacy in Manhattan that would fill the

Dr. Morrison and his colleagues conducted a telephone survey of 347
drugstores in all five boroughs, both chain and independent, asking
pharmacists whether they stocked various forms of morphine and other
opioids like fentanyl patches, hydromorphone and oxycodone.

The researchers used census data to identify white and nonwhite
neighborhoods. They defined nonwhite areas as those in which at least
60 percent of the residents were nonwhite. In white neighborhoods, at
least 80 percent of the residents were white.

Although some pharmacists cited fear of robbery as a reason for not
selling opioids, Dr. Morrison and his colleagues found that when they
took actual crime rates into account, the differences were not large
enough to account for the great difference in drug

But Mr. Corman said many pharmacists feared crime nonetheless, as well
as being duped by stolen or phony prescriptions, which he said
pharmacists could be fined for filling.

"I know some pharmacies who are very anxious about armed robberies,
and will have signs saying they don't carry narcotics," Mr. Corman
said. "Is that any different from a sign saying, 'We don't have more
than $50 in the drawer'?"

Asif Noor, a pharmacist interviewed at the Shawn Pharmacy on Wyckoff
Avenue in Ridgewood, Queens, said he did not carry the strongest
opioids, because they attracted addicts.

"People come with fake prescriptions, will start stealing and will
finish prescriptions very early and demand refills," Mr. Noor said.
"Once you have junkies in the store, then the government starts
watching you."

Jim Schiffer, an owner of the Sunset Pharmacy in Sunset Park,
Brooklyn, said that he had been held up for opioid drugs many times
over the years and that other pharmacists even had to worry about
theft by their own employees.

"We're afraid of being targets, and the poor people suffer because of
that," Mr. Schiffer said.

In Minneapolis, Ed Findell at Diamond Lake Pharmacy, said he gave up
stocking opioids in 1984 because he was held up so many times.

"Eventually you learn and you just stop carrying it," Mr. Findell

Dr. Angel T. Ponce, a cancer specialist in Los Angeles who treats
mostly blacks and Hispanics, said that a quarter of the patients for
whom he prescribed opioids come back within three days, unable to fill
their prescriptions, regardless of what kind of insurance they had.

In a mostly black and Hispanic neighborhood on Chicago's South Side,
Jay Patel, a pharmacist at Southern Pharmacy, said those who stocked
opioids risked being robbed and had to deal with onerous paperwork.

"It's a headache," he said. 
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