Have Prescription, Must Travel:
A Look at the Link Between a Pharmacy’s Inventory
and the Racial Composition of Its Customer Base

By Phyllis Griffin Epps

A study recently published in the New England Journal of Medicine suggests that drug stocks of neighborhood pharmacies are dictated not by legitimate demand but by the racial composition of the neighborhood served. The study, which surveyed 347 pharmacies throughout New York City, revealed that most pharmacies located in predominantly non-white neighborhoods did not stock opioid analgesics, or painkillers, in quantities sufficient to meet legitimate demand. Over half, or 51 percent, did not have adequate medication in stock to treat a person in severe pain. Even when adjusted for age (which correlates with the prevalence of terminal illness and painful chronic conditions) and rates of burglary, robbery, and drug-related arrests, the results demonstrate that pharmacies in non-white neighborhoods are less likely to stock opioids than are pharmacies in white neighborhoods. In neighborhoods where the majority of residents are African American, Hispanic, or Asian, patients in pain and bearing prescriptions for painkillers often are forced to leave the neighborhood in order to get the medicine they need.

Opioid supplies did not differ significantly between chain and independent pharmacies. It is worth noting that ownership does not appear to make a difference. Those pharmacists representing chain pharmacies reported no specific corporate policies with regard to stocking opioids.

The collective failure of pharmacies to equitably ensure availability of painkillers to meet demand is further evidence that members of ethnic minorities are at substantial risk for the undertreatment of pain. Race is a proven factor in the treatment strategies prescribed by physicians. A study of Medicare beneficiaries found that physicians tend to prescribe less intensive or aggressive treatments for African Americans than for similarly situated white Americans. Another study found that Hispanics and African Americans were substantially undertreated for pain from fractures of long bones. Yet another found that postoperative pain was inadequately managed if the patient was not white. Whites are more likely than nonwhites to receive prescriptions for painkillers. The study of pharmacies in New York clearly demonstrates that whites also enjoy more convenience in filling those prescriptions.

The results of this study are consistent with evidence of a widening gap between the health status of white Americans and that of non-white Americans. The statistics should be familiar by now: African Americans have a higher overall incidence of cancer and a higher rate of death from cancer than any other racial or ethnic group. In "new" cases of AIDS, Hispanics and African Americans are grossly over-represented. In short, traditional measures prove that members of racial and ethnic subpopulations suffer worse health than their white counterparts. The gap is not easily explained, but the medical literature on the subject implies that systemic racial bias is a factor. In the pursuit of quality health care, nonwhites are more likely than whites to encounter barriers to appropriate medical treatment and to suffer worse health.

Nationally, the pharmacy industry is now on notice of its possible complicity in discrimination by allowing racial biases and misconceptions to result in the uneven delivery of health care to its customers. The results of this study should spur industry representatives to launch a campaign aimed at educating pharmacists about the moral pitfalls of discrimination by race and ethnicity and the resulting injury to business in the form of lost revenue.

04/19/00