Patients who take prescription opioids for chronic pain may have difficulty receiving treatment as new patients at primary care clinics, according to study results published in JAMA Network Open.
In this study, researchers conducted a telephone survey of 194 primary care clinics in Michigan to assess whether clinicians were willing to accept and continue prescribing opioids to new patients already on an opioid regimen for the management of chronic pain.
A total of 194 clinics were randomly assigned to be contacted by research assistants posing as children of patients with chronic pain who were taking long-term opioids (n=94 and n=100 receiving calls from patients with Medicaid and private insurance, respectively).
A total of 79 of the clinics that were contacted (40.7%) said their healthcare practitioners would not provide care to the simulated patient, 81 clinics (41.8%) were willing to schedule an initial consultation, and 33 clinics (17%) required more information before deciding whether to schedule an appointment. After receiving additional information, 1 clinic accepted the patient, 4 denied the patient, 20 stated they would decide after an initial visit, 7 referred the patient to a pain clinic, and 1 asked for medical records to be faxed.
Clinics with more than 3 vs 1 practitioners and community health centers were found to be more like to accept new patients who were on an opioid regimen (odds ratio [OR], 2.99; 95% CI, 1.48-6.04 and OR, 3.10; 95% CI, 1.11-8.65, respectively). Neither insurance status nor a clinic’s availability of medicine for opioid use disorders was found to affect acceptance status (OR, 0.92; 95% CI, 0.52-1.64 and OR, 1.10; 95% CI, 0.45-2.69).
Study limitations include the fact that all clinics were in the same state, which might hinder generalizability.
“The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could potentially lead to unintended consequences, such as conversion to illicit substances or reduced management of other medical comorbidities,” concluded the study authors.
Lagisetty PA, Healy N, Garpestad C, Jannausch M, Tipirneni R, Bohnert AS. Access to primary care clinics for patients with chronic pain receiving opioids. JAMA Netw Open. 2019;2:e196928.