JAMA Netw Open
Opioid stigma adds to racial bias in sickle cell care
Clinical takeaway: Bias in sickle cell care appears strongly linked to opioid use stigma, not just race or chronic pain. Clinician language in the chart may reflect and reinforce disparities in care; consider implementing appropriate anti-bias training.
Bias in healthcare is well documented, but its underlying drivers are often unclear. This study examines how overlapping factors—race, chronic pain, and opioid use—relate to biased language in clinical documentation.
In an analysis of nearly 40,000 clinician notes across more than 18,000 patients, negative descriptors such as “noncompliant” or “aggressive” appeared in 15% of notes for patients with sickle cell disease. Patients with sickle cell disease had higher odds of negative descriptors than Black patients without sickle cell disease and patients with other types of chronic pain, but similar odds to patients with opioid use disorder.
This pattern suggests that bias may be driven less by race or chronic pain alone and more by how opioid use is perceived. Most patients with sickle cell disease use opioids appropriately for pain and do not have opioid use disorder, yet documentation patterns resemble those seen in patients with opioid use disorder.
Bias also appears to be cumulative. Notes for patients with overlapping identities—sickle cell disease, Black race, chronic pain, and opioid use disorder—had the highest rates of negative language, approaching 20%. The most common descriptors were “refuse,” “noncompliant,” and “nonadherent,” language that may shape subsequent clinical decisions and perceptions.
“Although patients with sickle cell disease routinely use opioid medications to manage their chronic pain, the vast majority do not have an opioid use disorder,” said senior author Monica Peek, MD, MPH, a professor at the University of Chicago Medicine. “Within health professions and society as a whole, there is a persistent bias that stereotypes these patients primarily as ‘drug-seekers’ rather than regular people managing a chronic disease.”
The authors developed an anti-bias curriculum using roleplay and skills-based training to help clinicians recognize and mitigate biased thinking in sickle cell care. Early implementation among residents showed preliminary signs of improving awareness and reducing biased responses, although formal outcome data are still pending.
Source: Wesevich A. JAMA Netw Open. 2026 Apr 13. Negative descriptors of patients with sickle cell disease in the electronic health record