Assessing reasons for decreased primary care access for individuals on prescribed opioids: an audit study

Abstract

Many primary care clinics are resistant to accept new patients taking prescription opioids for chronic pain. It is unclear how much of this practice is specific to individuals who may be perceived to have aberrant opioid use. This study sought to determine whether clinics are more or less willing to accept and prescribe opioids to patients depending on whether their history is more or less suggestive of aberrant opioid use by conducting an audit survey of primary care clinics in 9 states from May to July 2019. Simulated patients taking opioids for chronic pain called each clinic twice, giving one of 2 scenarios for needing a new provider: their previous physician had either (1) retired or (2) stopped prescribing opioids for unspecified reasons. Clinic willingness to continue prescribing opioids and accept the patient for general primary care were assessed. Of 452 clinics responding to both scenarios (904 calls), 193 (43%) said their providers would not prescribe opioids in either scenario, 146 (32%) said their providers might prescribe in both, and 113 (25%) responded differently to each scenario. Clinics responding differently had greater odds (odds ratio = 1.83 confidence interval [1.23-2.76]) of willingness to prescribe when the previous doctor retired than when the doctor had stopped prescribing. These findings suggest that primary care access is limited for patients taking opioids for chronic pain, and differentially further reduced for patients whose histories are suggestive of aberrant use. This denial of care could lead to unintended harms such as worsened pain or conversion to illicit substances.

Engagement in Prescription Opioid Tapering Research: the EMPOWER Study and a Coproduction Model of Success

“…Stigma has been amplified by the frequent misperception that continued opioid use indicates an opioid use disorder and by blaming patients with chronic pain for opioid-related harms. A lack of high-quality longitudinal data for opioid use, analgesia effectiveness and functional improvement, opioid misuse, and opioid reduction has perpetuated reductive policies, poor pain care, increased bias and stigma, increased health risks and mortality [1][2][3][4] , and fractured patient-clinician relationships and has created barriers to care 5,6 . For instance, some physicians may decline to accept new patients with existing opioid prescriptions.…”

Central sensitization in opioid use disorder: a novel application of the American College of Rheumatology Fibromyalgia Survey Criteria

“…OUD stigma is a barrier to pain treatment. 57 Anticipation of OUD stigma involves expecting that one's pain complaints will not be believed. 26 This may be particularly relevant for patients with nociplastic pain.…”

Facilitating Overdose Risk Mitigation Among Patients Following a Clinician Office Closure: A Connecticut Case Study of the Opioid Rapid Response Program

“… 11 , 12 Physicians' time, reimbursement, clinic-specific policies, and lack of resources were cited as possible reasons for refusing to accept patients taking prescription opioids. 11 , 12 …”

“…10 Unfortunately, research studies have demonstrated reduced access to primary health care for patients receiving prescription opioids. 11,12 Physicians' time, reimbursement, clinicspecific policies, and lack of resources were cited as possible reasons for refusing to accept patients taking prescription opioids. 11,12 Building on the lessons learned from the ARPO collaboration, the Opioid Rapid Response Program (ORRP) was established as a national program in 2020.…”