People taking opioids for chronic pain may find it hard to find a new physician. Many clinics turn them away. In a secret-shopper study of 452 primary care clinics, almost half would not take a new patient like this. Often the clinic feared the law. Or it assumed the patient was misusing the drug. Turning these patients away puts them at greater risk.
Summary: Many people live with chronic pain and need opioids to manage it. But if they need a new doctor for any reason, it gets very hard. Few doctors are ready to prescribe opioids for pain that will not quit. A new survey of 452 primary care clinics confirms it. Almost half of all clinics in the US do not want patients who use opioids for pain. They fear legal trouble. They also assume the patient must be misusing opioids and headed for serious opioid addiction. But even if a patient misuses opioids, that is no reason to refuse care. Refusal may push the patient to street drugs.
Most Americans know it is hard to find a doctor who will treat chronic pain. It is even harder if they take opioids. People often call clinic after clinic before they get an appointment or find a doctor who will help. Patients are not imagining this. A new study shows it is a real problem for people in pain who need opioids. If they have to change doctors for any reason, they are in trouble.
The new study shows that almost half of all clinics in the US are wary of treating chronic pain patients who take opioids. Researchers at the University of Michigan ran the study. They used a method called “secret shopper.” A caller posed as a woman with chronic pain who takes opioids. The team called 452 primary care clinics in nine states to ask if they were taking new patients.
Why won’t doctors take new patients on opioids for chronic pain?
If the clinic said “yes,” the caller said she had insurance and needed a new provider for her chronic pain. She said her last doctor had retired or had stopped prescribing opioids. So the researchers called each clinic twice and used one of these stories each time. To the researchers’ surprise, 43% of all clinics said they would not prescribe opioids in either story (doctor retired or doctor stopped prescribing opioids). Only about 32% said their primary care providers (PCPs) might prescribe opioids in these cases. Another 25% gave mixed signals. It is clear that doctors are wary of taking patients on opioids. They turn them away without even looking at their health. The study also found that clinics were twice as likely to turn these patients away if they said their doctor had stopped prescribing their opioids for some reason. In those cases, clinics assume the person might have a problem with opioid misuse. The study suggests it is significantly hard for people with chronic pain to find the right medical care. And their odds drop even more if there are any signs that they may misuse opioids. Health experts warn that this kind of refusal may significantly raise the risk that a patient turns to street drugs. Researchers also looked at why some clinics are so wary of these patients. The clinics pointed to new legal rules and fear of getting into trouble for prescribing these drugs. The results match a 2019 study. In that study, researchers found that 40% of primary care physicians are highly reluctant to treat patients who need opioids for chronic pain. But this bias against opioid users is wrong, and it causes significant problems. So this study aims to show that this bias toward opioid users is real and that it blocks access to care. Health experts say that even if a person uses opioids for reasons other than pain, they still need medical help. In fact, people addicted to opioids need more medical help. Those are the very patients primary care physicians must be treating.
Frequently asked questions
Why is it hard to find a new doctor when you take opioids for chronic pain?
Many clinics simply turn these patients away. University of Michigan researchers ran a secret-shopper study. A caller posed as a woman in chronic pain who takes opioids. She phoned 452 primary care clinics in nine states. Almost half would not take her. Clinics fear legal trouble under new rules. Many also assume a patient on opioids may be misusing them.
What kind of doctor prescribes opioids for chronic pain?
Most patients turn to a primary care provider. But many will not take over an opioid script. In the study, only about 32% of clinics said their providers might prescribe opioids to a new pain patient. Another 43% said they would not. The other 25% gave mixed answers. That leaves patients calling clinic after clinic.
Are clinics more likely to refuse you if your last doctor stopped prescribing opioids?
Yes. Clinics were twice as likely to turn the caller away when she said her last doctor had stopped her opioids. They were less likely to refuse when she said her doctor had retired. In the first case, clinics assume she may be misusing opioids. They reject her without even looking at her health.
What happens when patients on opioids are refused care?
Health experts warn that refusal can push patients toward street drugs. Even a patient who misuses opioids still needs medical help. People addicted to opioids need more care, not less. A 2019 study found the same pattern. In it, 40% of primary care doctors were highly reluctant to treat patients who need opioids for chronic pain.
Related reading
Primary Care Physician Can Prescribe Addiction Medications · Opioid Use Disorder Treatment From Home by Telemedicine · Self-Care Training for Chronic Pain Outcomes · How Chronic Pain and Opioid Addiction Are Related
Sources
- Lagisetty PA, Healy N, Garpestad C, et al. Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids. JAMA Netw Open. 2019;2(7):e196928. PMID 31298712 · DOI 10.1001/jamanetworkopen.2019.6928.
- Agnoli A, Xing G, Tancredi DJ, et al. Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Long-term Opioids. JAMA. 2021;326(5):411-419. PMID 34342618 · DOI 10.1001/jama.2021.11013.