Opioid Use A Barrier for Primary Care, Study Finds

Primary care practices are more likely to turn away patients taking opioids for chronic pain, according to a new study.

“Anecdotally, we were hearing about patients with chronic pain becoming ‘pain refugees’, being abruptly tapered from their opioids or having their current physician stop refilling their prescription, leaving them to search for pain relief elsewhere,” said lead study author Pooja Lagisetty, MD, MSc, in a press release. “However, there have been no studies to quantify the extent of the problem.”

The researchers used a commercial database of office-based practitioners to randomly select 667 primary care clinics located in Michigan, which were stratified by practice size (1–3 or > 3 practitioners). Clinics were contacted via telephone between June 22, 2018, and Oct. 30, 2018, and asked about the number and type of practitioners, insurances accepted, appointment availability, and if medications were used to treat opioid use disorders (OUDs). Four research assistants called the clinics posing as children of women who needed a primary care appointment. The researchers chose this approach so patients would not be asked to give identifying details like Social Security numbers and birthdates.

“The calls were structured to allow for different clinic-level practices on addressing the patient’s opioid use (eg, continuing opioid prescribing, case-by-case evaluation, and offering tapers after initial meetings),” the study authors elaborated. “We also examined whether clinics would be more willing to provide care if the patient had private vs Medicaid insurance and by whether the clinic provides OUD treatment.”

Opioid Users Have a Difficult Time Finding Care

Of the 667 clinics selected, 219 were eligible for inclusion, and 194 completed the phone call; 94 clinics were called with research assistants posing as Medicaid patients, and 100 as Blue Cross Blue Shield patients.

“Of these clinics, 79 (40.7%) stated that their practitioners were not willing to provide care for new patients taking opioids. A total of 81 clinics (41.8%) were willing to schedule an initial appointment,” the researchers found. “An additional 33 clinics (17.0%) requested more information before making a decision. After receiving this information, 1 clinic accepted the patient, 4 did not accept the patient, 20 stated that the practitioner would decide about opioid prescribing after the first visit, 7 stated that they would refer the patient to a pain clinic, and 1 requested faxed medical records.”

Clinics that had more than three practitioners were more likely to accept new opioid-using patients than clinics with only one practitioner (odds ratio [OR], 2.99; 95% confidence interval [CI], 1.48-6.04). Community health centers were also more likely to accept patients currently using opioids (OR, 3.10; 95% CI, 1.11-8.65). There were no significant differences between clinics’ willingness to accept patients using opioids based on patients’ insurance status (OR, 0.92; 95% CI, 0.52-1.64) or whether the clinic provided OUD treatment (OR, 1.10; 95% CI, 0.45-2.69), or was urban (OR, 0.65; 95% CI, 0.37-1.16).

“These findings are concerning because it demonstrates just how difficult it may be for a patient with chronic pain searching for a primary care physician,” said Dr. Lagisetty. By restricting access to care, these patients may resort to using other substances to treat their pain, and they may be unable to manage other comorbidities.

“Everyone deserves equitable access to health care, irrespective of their medical conditions or what medications they may be taking,” Dr. Lagisetty said.