The Deserving Pain? Determining Legitimacy of Opioid Use in Sickle Cell Patients

• In Event: 2184 - Section on Medical Sociology Refereed Roundtable Session
  In Refereed Roundtable 60min: Table 14. The Prescription Drug and Opioid Epidemic

Abstract

How do health care providers decide whether patients should be treated with opioid pain killers? In light of the American opioid crisis, the use of prescription opioids in treating pain has come under increased scrutiny. Political pressures have demanded that health care providers prescribe potentially-addictive opioid medications more cautiously and screen patients for drug-seeking behaviors more carefully. However, determining the legitimacy of requests for pain treatment can be challenging because pain is invisible – it cannot be measured objectively via biomarkers. As a result, health care providers rely on patients’ subjective reports of pain, a practice that leaves providers vulnerable to fabrication and exaggeration. Through an ethnography of multidisciplinary rounds at a large urban hospital, I find that providers draw from their own subjective assessment of patient status in order to verify patient self-reports of pain. Aspects of patients’ depth of medical knowledge, frequency of hospital usage, self-presentation, and family structure are used as counter-evidence when providers argue that patients are malingering rather than truly ill. Provider assessments can override patient self-reports even in the presence of objective evidence of pain-producing illness, such as in the case of patients with sickle cell disease, a genetic blood disorder that is most common among people of African origin. This finding conflicts with sociological theory on the relationship between genetics and legitimacy, which suggests objective evidence should trump subjective evaluation and provide support for patient legitimacy, and may be evidence of racial bias in medical decision-making. I discuss the implications of this study for medical sociology and racial health disparities.

Author

• Alexandra E. Brewer, University of Chicago