"We don't carry that" - Failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics

Background: We have observed that many black and Hispanic patients receivin g palliative care at a major urban teaching hospital are unable to obtain p rescribed opioids from their neighborhood pharmacies. In this study, we inv estigated the availability of commonly prescribed opioids in New York City pharmacies. Methods: We surveyed a randomly selected sample of 30 percent of New York C ity pharmacies to obtain information about their stock of opioids. For each pharmacy, U.S. Census estimates for 1997 were used to determine the racial and ethnic composition of the neighborhood (defined as the area within a 0 .4-km [0.25-mile] radius of the pharmacy) and the proportion of residents w ho were more than 65 years old. Data on robberies, burglaries, and arrests involving illicit drugs in 1997 were obtained for the precinct in which eac h pharmacy was located. We used a generalized linear model to examine the r elation between the racial or ethnic composition of neighborhoods and the o pioid supplies of pharmacies, while controlling for the proportion of elder ly persons at the census-block level and for crime rates at the precinct le vel. Results: Pharmacists representing 347 of 431 eligible pharmacies (81 percen t) responded to the survey. A total of 176 pharmacies (51 percent) did not have sufficient supplies of opioids to treat patients with severe pain. Onl y 25 percent of pharmacies in predominantly nonwhite neighborhoods (those i n which less than 40 percent of residents were white) had opioid supplies t hat were sufficient to treat patients in severe pain, as compared with 72 p ercent of pharmacies in predominantly white neighborhoods (those in which a t least 80 percent of residents were white) (P<0.001). Conclusions: Pharmacies in predominantly nonwhite neighborhoods of New York City do not stock sufficient medications to treat patients with severe pai n adequately. (N Engl J Med 2000;342:1023-6.) (C) 2000, Massachusetts Medic al Society.