Abstract
Opioid-prescribing policies and guidelines aimed at reducing inappropriate opioid prescribing may lead physicians to stop prescribing opioids. Patients may thus encounter difficulties finding primary care practitioners willing to care for them if they take opioids. To assess practitioner willingness to accept and continue prescribing opioids to new patients with pain and whether this willingness differs across payer types. This survey study used a simulated patient call audit method. A brief telephone survey was administered to all clinics followed by a call using a patient script simulating an adult patient with chronic pain who was taking long-term opioids. The patient had Medicaid or private insurance. Calls were made between June 22 and October 30, 2018, to 667 primary care clinics that served a general adult population in Michigan. Clinics that accepted both Medicaid and private insurance, took new patient appointments, and were successfully recontacted for the simulated call were eligible for the study. Prevalence of clinics' acceptance of new patients receiving prescription opioids overall and by clinic characteristics and insurance type. Of the 194 eligible clinics, 94 (48.4%) were randomized according to insurance type to receive calls from research assistants posing as children of patients with Medicaid and 100 (51.5%) to receive calls from those with private insurance. Overall, 79 (40.7%) stated that their practitioners would not prescribe opioids to the simulated patient. Thirty-three clinics (17.0%) requested more information before making a decision. Compared with single-practitioner clinics, clinics with more than 3 practitioners were more likely (odds ratio [OR], 2.99; 95% CI, 1.48-6.04) to accept new patients currently taking opioids. No difference was found in access based on insurance status (OR, 0.92; 95% CI, 0.52-1.64) or whether the clinic offered medications for opioid use disorders (OR, 1.10; 95% CI, 0.45-2.69). The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or reduced management of other medical comorbidities.
Highlights
Since the 2000s, the number of opioid-related overdoses has continued to increase.[1,2] Many of these overdoses have been associated with increased use of prescription opioid analgesics.[3]
No difference was found in access based on insurance status (OR, 0.92; 95% CI, 0.52-1.64) or whether the clinic offered medications for opioid use disorders (OR, 1.10; 95% CI, 0.45-2.69)
The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or reduced management of other medical comorbidities
Summary
Since the 2000s, the number of opioid-related overdoses has continued to increase.[1,2] Many of these overdoses have been associated with increased use of prescription opioid analgesics.[3]. Monitoring programs and limits on dosages of opioids being prescribed and duration of opioid therapy.[4,5] In Michigan, prescribers are mandated to check the prescription drug monitoring program before every new and old prescription; complete an Opioid Start Talking Form, which discusses the risks and benefits of opioids; and have a bona fide patient-prescriber relationship with the patient to initiate opioid therapy.[6] In addition, the 2016 Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain emphasizes using nonopioid therapies for chronic pain and trying to use the lowest effective dose if opioid therapy is indicated.[5] Many of these guidelines and policies have achieved the desired result of reduced opioid prescribing.[7,8] stakeholders have expressed concern that these new policies have led physicians to stop prescribing opioids completely, even to certain patients for whom the benefits of opioids may outweigh the risks.[9,10]
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