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In their article Racial Bias in the U.S. Opioid Epidemic: A Review of the History of Systemic Bias and Implications for Care, Santoro et al. (2018) outline the historical stigma of chemical addiction and link it to the problems in pain management that exist in America’s healthcare system. They state that addiction has long been viewed as an individual’s moral weakness, but that neuroscience studies conducted in the 1990’s proved to the medical field that addiction has a pathology like any other brain disease. However, that research does “not address the interplay between environmental and physical triggers”, nor does it change society’s perception that easily (Santoro et al., 2018, p.2). Even though biases continue to be reinforced by media portrayal and pharmaceutical marketing, “non-medical use of opioid base prescription pain relievers is two times greater in the Caucasians than in the non-white minority” (Santoro et al., 2018, p. 4). So opioid addiction is not merely a moral failing, nor are opioids necessarily being used or sought more by the minority population. Still, bias exists in the practice of prescribing opioids for pain relief to non-white clients.

Both Santoro et al. (2018) and Keister et al. (2021) reported evidence that not only pain treatment in general, but specifically opioids, are less likely to be prescribed to non-white minorities than their Caucasian counterparts. Keister et al. studied an ED over several years and concluded that providers were less likely to prescribe opioids during times when the ED was especially busy (overcrowded), but that they were more likely to prescribe to patients with a history of receiving opioids in the ED. This may indicate a provider’s desire to hurry through interactions in times of overcrowding without careful consideration of the patient’s medical diagnosis. When diagnostic differences were considered, it was still found that providers were “less likely to prescribe opioid analgesics to racial minorities relative to white patients” (Keister et al., 2021, p. 7).