Pain Patients Who Take Opioids Can’t Get in the Door at Half of Primary Care Clinics

“Secret shopper” study finds stigma is highest against those who say their last doctor stopped prescribing opioids to them.

1:05 PM

Author | Kara Gavin

doctor holding hand up in mask with glasses and mask
Getty Images

People who take opioid medications for chronic pain may have a hard time finding a new primary care clinic that will take them on as a patient if they need one, according to a new "secret shopper" study of hundreds of clinics in nine states across the country.

Stigma against long-term users of prescription opioids, likely related to the prospect of taking on a patient who might have an opioid use disorder or addiction, appears to play a role, the Michigan Medicine research suggests.

Simulated patients who said their doctor or other primary care provider had retired were more likely to be told they could be accepted as new patients, compared with those who said their provider had stopped prescribing opioids to them for an unknown reason, according to the paper in the journal Pain.

The Michigan Medicine primary care provider and health care researcher who led the new study, Pooja Lagisetty, M.D., M.Sc., hopes that her team's new findings could help primary care clinics look at their practices regarding existing or prospective new patients.

MORE FROM MICHIGAN: Sign up for our weekly newsletter

"We need to make sure we're training prescribers and their teams in addressing the systemic biases that this research highlights," says Lagisetty, a general internal medicine physician at Michigan Medicine, the University of Michigan's academic medical center. "We shouldn't even be thinking about the reason that patients are giving when they seek to access care.

"Even if you think that someone is using opioids for a reason other than pain, or that long-term opioids are not an effective pain care strategy, those are exactly the patients we in primary are should be seeing," she adds. "Restricting their primary care access limits their ability to engage in pain-focused care and potentially addiction-focused care." 

SEE ALSO: How Primary Care Doctors Can Help Patients Beat Opioid Addiction

It also worsens stigma, she says, by suggesting that people using opioids for pain are more worthy of receiving care than those who may have addiction.

She and her colleagues had seen signs of stigma against patients on long-term opioids for non-cancer pain in a previous study that used the "secret shopper" technique to call clinics in Michigan. But the new study takes that to a new level, with data from 452 clinics in nine states.

Each clinic responded to two calls, separated by time, from a female caller who asked if the clinic was taking new patients, said she was covered by a major insurer in the area, and said she had been taking opioids for years for pain. Depending on the call, she then either said that her last provider had retired or stopped prescribing opioids, leading her to seek a new primary care clinic and asking if their providers would potentially continue to prescribe opioids after a visit.

Even if you think that someone is using opioids for a reason other than pain, or that long-term opioids are not an effective pain care strategy, those are exactly the patients we in primary are should be seeing.
Pooja Lagisetty, M.D., M.Sc.

All of the clinics included in the study said they were taking new patients, but when the patient mentioned wanting to receive opioids, 43% of the clinics said they were no longer willing to schedule the appointment.

"This suggests that many clinics are likely just shutting their door to any patient needing an opioid prescription despite the reason for needing a new provider," says Lagisetty, who is also a member of the U-M Institute for Healthcare Policy and Innovation. "Clinics often stated to the patient that this was due to new policies, fear of legal ramifications, or administrative burdens." 

She adds that barriers to treating opioid addiction in a primary care setting, including the special training needed to prescribe buprenorphine and the added support needed to help patients receiving medications for opioid use disorder, may have contributed to this. Recent signs that the federal requirements may be relaxed could help change this, but only if primary care providers receive help and training in providing this kind of care.  

Like Podcasts? Add the Michigan Medicine News Break on iTunes, Google Podcast or anywhere you listen to podcasts.

Nearly one-third (32%) of the clinics said they would schedule the patient for an appointment and the primary care provider would potentially continue to prescribe opioids, no matter which scenario the patient gave.

But the remaining 25% of clinics gave mixed signals when called twice. In those clinics, patients had nearly 2 times the likelihood of getting scheduled if their prior physician had retired as compared to those who said their last doctor had stopped prescribing for unknown reasons. 

"In these cases, where clinics gave different answers depending on the scenario presented, it is harder to argue that stigma around opioid use, pain, and addiction is not playing a role in clinic decision-making," says Lagisetty.

In addition to Lagisetty, the study's authors are Colin Macleod, Jennifer Thomas, Stephanie Slat, Adrianne Kehne, Michele Heisler, and Amy S.B. Bohnert of the University of Michigan, and senior author Kipling Bohnert of Michigan State University.

Paper cited: "Assessing reasons for decreased primary care access for individuals on prescribed opioids," Pain. DOI: 10.1097/j.pain.0000000000002145


More Articles About: Industry DX chronic pain Health Care Delivery, Policy and Economics Primary Care Hospitals & Centers Pharmacy Patient Safety Pain management
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories Older couple holding hands
Health Lab
In sickness and in health, older couples mostly make Medicare moves together
A new study suggests the need for more efforts to help both members of a couple weigh and choose their Medicare options together, because most changes of plan occur with both members of the couple changing from the same option to the same option.
Speculum illustration including a gloved hand holding a swab in front of microscopic cells
Health Lab
U.S. could cut cervical cancer cases, deaths by up to 20% if more patients followed up after screening, study suggests
Many women don’t get cervical cancer screening such as Pap tests, or don’t go for follow up diagnostic tests; a new study shows what could happen if all of them did.
Spilled pills next to a stethoscope and pile of cash
Health Lab
Drug pricing program improved prostate cancer treatment adherence
Socially vulnerable patients were more likely to stick with oral medications when treated at a hospital participating in 340B program, suggesting these hospitals may have more resources to help patients.
gun with lock on it with key there gun is in black and background yellow and lock is white
Health Lab
Michigan’s new firearm injury prevention laws: What everyone should know
Michigan has a set of new laws related to firearms, all designed to reduce the risk of injury and death across the state.
computer
Health Lab
Same patient. Different visit. Different race and ethnicity?
Data on the race and ethnicity of patients underpins efforts to reduce health care disparities, but a study shows inconsistent recording in emergency departments
Blurred image of health care professionals in blue scrubs pushing a gurney down a hallway
Health Lab
Primary care scarcity linked to more surgical emergencies, problems
Patients living in areas with the worst shortages of primary care providers are more likely to have emergency surgery, surgical complications and hospital readmissions.