 Opioids are synthetically manufactured drugs which are structurally very similar to opium which occurs naturally. It's a narcotic drug and it has a really high potential for addiction. So many people who are addicts start out on a prescription opioid from their physician or emergency room and it's very effective in pain control but it has this huge potential for addiction so many people start out on this and then they become regular users of opioid and sometimes also switch to heroin. It kills about 40 people every day so it's a huge magnitude and cannot be really ignored. I look at emergency room visits for dental problems as one of the outcomes for my research and I also have conversations with emergency physicians and they always said that well we don't know whether that dental patient was there for actual problem or they were just there seeking opioids and drugs and so that made me look for evidence and when we didn't find any we thought we really need to look at this. So we used data from 2007 to 2011 so five years of data and that is a sample of nationally representative emergency room visits that occur in the US. And when we did our analysis our hypothesis was partially confirmed so we did not find any racial disparities in long bone fractures, kidney stones and actually also tooth aches but we did find racial disparities for ED visits for back pain and for abdominal pain. So we hypothesized this because many times drug seeking behavior is associated with ED visits for back pain, abdominal pain and tooth pain but our findings were slightly contradictory that tooth pain we did not have any racial disparities and we think that may be because sometimes dental problems can be clinically obvious there could be a swelling in the jaw there could be abscesses or if the physician opens them out they might see a cavity so they would be more they would trust the patient more to actually prescribe opioids even if they were racial minorities but when it comes to the other vague conditions like back pain and abdominal pain if you were a minority patient especially a non-Hispanic black patient and you went with the same level of pain and insurance and age and all those other factors you were almost half as likely to receive opioids as a white patient. I think it's really important in the current times with the magnitude of the opioid epidemic and also the nature of race relations in our country and it just shows that the racial discrimination and the bias creeps in our healthcare as well. I do believe that many a times this is unconscious on the part of the provider they do not consciously discriminate against black patients but we all have inherent biases and one of the things that I think which could really change the way clinical care is administered is sensitization to our own biases and at UCSF there was this one program where they started doing a survey or a quick quiz which sort of shows you your own biases and I was really surprised I did take it and I had a slight bias against a particular group so I am not consciously aware of that but many times we might have such biases and I think especially at the stage of medical students, dental students and their clinical residents if we have this type of practice and we take steps to consciously avoid those biases that could really change the practice.