The response to drug epidemics cuts along lines of race and class. In my recent piece with Toni Monkovic in the New York Times’ Upshot Dr. M. Norman Oliver, Virginia’s health commissioner, said, “At the beginning, the opioid epidemic was centered in rural Appalachia, and as long as it involved poor rural whites, it did not get much attention. When those prescription opioids hit the more affluent white suburbs around big cities, that’s when people started paying attention.”

The piece goes on,

Race-based physiological myths have long influenced medical practice, he said. Even today, some doctors believe that African-Americans are more tolerant of pain. One study found that relative to other racial groups, physicians are twice as likely to underestimate black patients’ pain.


Several years ago, researchers at the University of Virginia, including Dr. Oliver, probed the beliefs of 222 white medical students and residents and published results in the Proceedings of the National Academy of Science. Half held false physiological beliefs about African-Americans. Nearly 60 percent thought their skins were thicker, and 12 percent thought their nerve endings were less sensitive than those of white people.


The medical students and residents who endorsed false beliefs like these were more likely to rate the pain of a black patient as less severe than that of an otherwise identical white patient and less likely to recommend treating black patients’ pain.


Other studies show that physicians, white ones in particular, implicitly prefer white patients, falsely viewing them as more intelligent and more likely to follow professional advice.


In 2013, the American Medical Association — the largest medical association in the United States — published a review of the relationship between pain and ethnicity in its Journal of Ethics. It concluded that variations in treatment stem in part from racial misconceptions about heightened pain tolerance among African-Americans and from the false notion that blacks and Hispanics are more likely than whites to abuse drugs.

As a consequence, nonwhite patients receive less pain treatment. There are also race-based disparities in treatment for heart diseasecancerdiabeteskidney disease, among many other illnesses.