Access to Opioids Among Chronic Pain Sufferers


For chronic pain sufferers using opioids, policy changes have made it difficult to find new primary care providers — which investigators warn could have unintended consequences.

Opioid prescriptions

A recent study is illustrating the negative impact of changes in opioid prescribing policies have had for patients with chronic pain receiving opioids. 

Investigators from the University of Michigan found that guidelines and policies seeking to reduce inappropriate opioid prescribing could lead to unintended consequences among chronic pain sufferers, including conversion to illicit substances. 

Using a simulated patient call audit method, investigators assessed practitioner willingness to accept and continue prescribing opioids to new patient with pain and whether or not this willingness differed among various payer types. Investigators obtained a list of 4850 primary care practitioners in Michigan from a commercial database. 

Of the 4850, a group of 667 clinics were selected and stratified by practice size (1 to 3 or more than 3 practitioners). Investigators performed simulated patient calls, where research assistants using a standardized script to pose as the child of an adult woman who needs a new primary care appointment, with these clinics between June 22 and Oct. 30, 2018. 

Clinics were surveyed about the the number and type of practitioners, insurances accepted, appointment availability, and whether their practitioners use medications to treat opioid use disorder (OUD).

Of the 667 clinics screened, 219 were eligible after application of inclusion criteria. Of the eligible clinics, 88.6% (194) completed the scripted call. Of that group, 94 clinics were allocated to simulated patient calls with Medicaid and 100 to Blue Cross Blue Shield.

Investigators found that 40.7% of the clinics called said they would not provide care to new patients taking opioids, 17% requested further information, and 41.8% were willing to schedule an initial appointment. After receiving the requested info, 1 clinic accepted the patient, 4 did not, 20 said the practitioner would decide about prescribing following the first visit, 7 stated they would refer the patient to a pain clinic, and 1 requested faxed medical records.

When comparing results based upon number of practitioners, investigators noted that single-practitioner clinics were more likely than clinics with 3 practitioners or more to accept new patients currently taking opioids (OR, 2.99; 95% CI, 1.48-6.04). Investigators found that clinics that were community health centers were more likely to accept new patients taking opioids. No differences were observed when comparing acceptance rate based upon insurance status.

Within their conclusion, investigators noted that policy changes that impact access may lead to a patient seeking out illicit substances or to reduced management of other comorbidities. 

This study, titled “Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids,” is published in JAMA Network Open. 

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