Dr C. Patrick Carroll on Biases Impacting African Americans With Sickle Cell Disease and Pain

Patients with sickle cell disease already face suspicion and biases based on their need for opioids, and African American patients also face additional racial biases, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

Transcript

Sickle cell is a disease that disproportionately affects African Americans—do you think that racial disparity impacts how the disease is treated and how pain is managed?

Yeah, it's a very rare adult with sickle cell disease—as a matter of fact, I don't think I've ever met anyone, and adult with sickle cell disease, who hasn't come to an ED [emergency department] at least once and been accused of being addicted. It's almost a universal experience in our patients.

So, I do suspect that racial biases play a role in that. But, you know, racial bias is built into the DNA of our society and to some extent to their medical system, as well. So, it affects where people live, it affects how their schooling goes, it affects their jobs, and so it's pervasive and it is pervasive. In the medical system too, and then with respect to pain care, we know that African American patients tend to get underevaluated and undertreated. So, you can certainly believe that that happens with sickle cell disease.

And then on top of that, my team and I have traveled to places where providers and patients are typically the same ethnicity. and you see very much the same biases around sickle cell disease itself, which I think again, has to do with the fact that you have severe acute pain with no identifiable signs is treated with opioids. And so, it's just ripe for suspicion. And so, our patients really get hit from all directions.