‘First Do No Harm’
Physician discretion, racial disparities and opioid treatment agreements
Bibliographic Data
| ID | 21515170 |
|---|---|
| Authors | Adrienne Sabine Beck (The Ohio State University), Larisa Svirsky (0000-0001-8786-6971, Brandeis University), Dana Howard (0000-0001-7793-2912, Oklahoma State University Medical Center, corresponding author) |
| Year | 2022 |
| Volume | 48 |
| Issue | 10 |
| Pages | 753-758 |
| Publication date | 2022-10-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Journal of Medical Ethics (JOURNAL) |
| Journal identifiers | ISSN: 0306-6800 • E-ISSN: 1473-4257 |
| Publisher | BMJ (PUBLISHER • GB) |
| DOI | 10.1136/medethics-2020-107030 |
| PMID | 34330795 |
| OpenAlex | W3184309628 |
| Language | EN |
| References cited | 41 |
The increasing use of opioid treatment agreements (OTAs) has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable
Business · Discretion · Harm · Health care · Political science · Public relations · Law · Medicine · Opioid Use Disorder Treatment · Pain Management and Opioid Use · Prenatal Substance Exposure Effects
CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014
Racial Bias in Perceptions of Others’ Pain
Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments
The Opioid Crisis in Black Communities
Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain
CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
Implicit bias in healthcare professionals
A Superhumanization Bias in Whites’ Perceptions of Blacks
Reconciling Patient Safety and Epistemic Humility
Toward Fair and Humane Pain Policy
Opioid Treatment Agreements and Patient Accountability
Implicit Discrimination
Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes
Reducing Racial Health Care Disparities
Incarceration, Health, and Racial Disparities in Health
| Highly cited | No |
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