1. Opioids: Race, Class, and Gender Discrepancies
Johnathan Goree, MD
Director of Chronic Pain Division
Chair of Opioid Stewardship Committee
Assistant Professor
Department of Anesthesiology
University of Arkansas for Medical Sciences

2. Disclosures
I have no financial interests to disclose related to this presentation

3. Outline What does our physician/provider work force look like
Are pain outcomes different for under-represented groups?
What are the factors that affect these outcomes?
What can we do to address the problem?

4. United States of America

5. United States of America
2010 Census Data – Sex
Female %
Male %

6. United States of America
2016 FSMB Census of Licensed Physicians
Female %
Male %
2016 AAMC Medical School Survey (Faculty Members)
Female %
Male %

7. United States of America
2010 Census Data - Race
White %
Hispanic/Latino American %
Black %
Asian %
Native American %
Two or More Races %
Other %

8. United States of America
2016 AAMC Medical School Graduation Data
White %
Asian %
Black %
Hispanic or Latino %

9. Arkansas

10. Arkansas 2010 Census Data Women - 51.2% Men - 48.8% White - 77%
Black %
Latino or Hispanic %
Asian %
Native American %

11. Does This Matter?

14. JAMA Pediatrics Journal Club Slides: Racial Disparities in Pain Management for Appendicitis
Goyal MK, Kuppermann N, Cleary SD, Teach SJ, Chamberlain JM. Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. Published online September 14, doi: /jamapediatrics

15. Results
Predicted Probabilities for Analgesic and Opioid Administration by Race Stratified by Pain Score and Adjusted for Ethnicity

16. Results
Predicted Probabilities for Analgesic and Opioid Administration by Race Stratified by Pain Score and Adjusted for Ethnicity

19. 7000 patients in 12 centers
No difference in pain scores
Mount Sinai Hospital (NY, NY); Medical University of South Carolina (Columbus, SC); UCLA (Los Angeles, CA); Colorado SOM (Aurora, CO)

20. UAMS.
Multi-logistic regression comparing patient characteristics of trauma patients.
G. Lawson Smith, Rebecca Reif, Kevin Sexton, Johnathan Goree
Odds Ratio for Black patients 0.64 (0.56,0.73)

21. Discussion of Possible Reasons

22. Discussion Patient Provider Systemic Cultural Health literacy
Distrust of medical profession/ lack of disclosure
Provider
Implicit Bias
Poor communication
Systemic
Cultural

23. Discussion Patient Provider Systemic Cultural Health literacy
Distrust of medical profession/ lack of disclosure
Provider
Implicit Bias
Poor communication
Systemic
Cultural

24. Implicit Bias Unconscious stereotypes.
“Even the most well-intentioned individuals, such as Emergency Medicine Physicians (who choose to work in highly disadvantaged areas and) provide the ‘safety net’ of our healthcare system can lean towards unconscious stereotypes when fatigued or required to make quick decisions with little information”

26. * * * *

28. Most Likely  Least Likely

29. How do we combat racial, gender, and class bias in healthcare
1) Understand our own biases.
2) Challenge ourselves
3) Strive towards a culture of diversity and inclusion

31. Challenge ourselves Source: Armenta,K and Bain,B 2008
Ask ourselves where our thoughts and behaviors come from. Find the source and cease self-blame
Attend workshops
Be open to change
Develop awareness of your own thoughts
Take a risk: Be the only person in a group of people different than you.

32. Push for Diversity and Inclusion
Push for Diversity and Inclusion in organizations that you are apart of.
Diversity = what you have. Snapshot. Can be accomplished through leadership
Inclusion = what you do. Movie. Must be accomplished through culture change throughout organization.

33. Summary
Unconscious and Conscious Bias can and do affect healthcare outcomes, especially in patients with chronic pain.
A blanket decrease in opioid administration without an understanding of the entire picture can lead to unintended consequences.
We must be careful, especially as we rapidly decrease opioid use, that we don’t negatively impact the care of women and minority groups.

34. Questions about the Topic
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35. Case Conference and Feedback
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