40% of doctors refuse new patients taking opioids

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids – Jama Network Open – July 2019

This JAMA study shows that 40% of doctors refuse a new patient if they are using opioids. Many refuse not just to manage their pain, but to manage any other aspect of their general health.

Findings  In this survey study of Michigan primary care clinics, 79 clinics contacted (40.7%) stated that their practitioners would not accept new patients receiving opioid therapy for pain. There was no difference based on insurance type.

Meaning  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 poor management of other mental and physical comorbidities.  

Importance  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.

Objectives  To assess practitioner willingness to accept and continue prescribing opioids to new patients with pain and whether this willingness differs across payer types.

Results  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).

Conclusions and Relevance  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.

Introduction

To reduce inappropriate opioid prescribing, several agencies, including insurance companies, have initiated policies that mandate clinical practices, such as mandatory checks of prescription drug monitoring programs and limits on dosages of opioids being prescribed and duration of opioid therapy

Many of these guidelines and policies have achieved the desired result of reduced opioid prescribing. However, 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.

Patients may thus encounter difficulties finding primary care practitioners willing to care for them if they take opioids. 

Popular media outlets have described this population that is now being displaced from health care systems as opioid refugees.

Primary care practitioners may still be willing to provide care for other medical issues, such as hypertension, but they may turn away new patients who need opioids for pain.

Many experts have expressed concern that abandoning this population could lead to unintended consequences, such as increased use of more potent illicit opioids or potentially even increased risk of suicide.

However, thus far to our knowledge, there have been no quantitative studies to fully assess the scope of this phenomenon.

Conclusions

The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could potentially lead to unintended consequences, such as conversion to illicit substances or reduced management of other medical comorbidities.

11 thoughts on “40% of doctors refuse new patients taking opioids

  1. brucespoint

    Even in Canada!!! Dammit@DiC Nixon’s Voter Caging plan@Still Werking it’s atroCities, nOw US. Have something said@FB Pain page/ Not mine/ @Death With Dignity card played as Soon as apprOpriet. But, B4 that, NW Ontario the whole NW’st Hub@Everything@Natives too, muCh Bad Blood there, too bad, as Canadian Legitimacy rests on Treaties, honoured mOre than South of Me, butt still… Nation Up for Grabs in Not Done Right, Move in USA/ China/ Russia, That CritiCal. USA = Same@Rule of Law/ Not Mans Rules/ No Longer Legit???
    Anyhoo, took 7 years to get a Family Dr, Leaving Me suCkin Wind fOr Rx’x, when Angel Nurse Practicianors Supervising DR, Who Wrote/ backed Rx’z retired from General Practice, ehcos still happening Here, Finnaly got Fresh@School grad brand new minted Dr@Training Wheelz, but LOCAL = Staying till We’re ded! a Winn! But still on thOse wheelz, need ‘Specialist to increase Any Rx’z… Yikes@No Balls “Pain Doc” Hiding frOm “Mee”!!!!!!
    New Doc there thO, Old one Hides/ sends kid no experiAnCe idiOt, to Give BAD News, No New Rx’z = Evah, after Trying fOr Hoop Jumped “LyriCa”!!!.ick.ick.ick…!
    NeuRotten STOPS ALL Dendrite@BrainsCellz!!! = Dying of ALZ “I” Fear/ HeadStart!!!
    This Kid getz Bent@”Me” cuz NOT Happi bout That!!! Peek a’ Boo Dr whatz His Name HiDES!! No Calls fOr Scheduled ServiCes, Ohh, We’ll Call You Crap@Nevahh Do Dammit.
    So, Workinn out “My” Writin, old Stuff@My MediCal ReCord = Get this Stuff Strait! God’Dammed DR’s NEVER Listen/ When Forced To/ = HiDE!
    HayZeus!!!
    Let Me fetch Death w/ Dignity bit 2 finish This Missive@Thank You Zyp Czyk 4 Being!

    “DeathW/-Dignity@Canadian.rtfd

    Alces Acres In Canada, We now have “Death with Dignity” as the rule of Law Now. I tested That last year, telling Dr’s, That “I” was Very Serious about That, in Case they felt Any pull from Outside to Yank them, as has happened thru mis adventure too many times before to where I have “my” perfect Taper of, verry verry lilttle Twitching involved, Thru Practice, Dammit!
    • Dr’s writing Scripts Rx’d by True Angel Nurse Practicioner helping ‘Me” too, as part of the pkg made by ‘my” hubris about Night Vision that I’d made a living from 9 years seasonally, Truly a Job “I’d” do for Free, just cuz sooo Much Fun! Ask! I Spill, so Careful what you ask, depending on Subject, like thee taper, assisted, abOve, that werkz4Me.
    • Stating@Intended planned Death, Mine 0wn, did Finally get their damned attention! … but made tiptoe talking a thing, a Bug.; Not a Feature. Specially in the Case of “Pain Centre” local, good thing, any other Canadian citi, @least 400+++ miles away this small town/ Citi/ Regional Hub 4 NW Ontario… Gotta keep plugging@iT!!!
    • Evah, till Ded.
    • Hang Folks, tide IS Comin back inn.🤗
    • Any Question ASK, or chck Alces Acres’ notes@Public PSA setting here, on Markie’ Z’zz PlayToy.











    b.
    Ever get to FB anynOre, eh?
    Sent a Friend request.

    Like

    Reply
    1. Zyp Czyk Post author

      Nope – i very rarely look at Facebook. I can’t handle Facebook intrusiveness into everything else I do with my device or online – even after I log out or close the browser… and I don’t like how they track every move we make and then sell our data to corporations that can use it manipulate us – and who else are they selling it to?

      Liked by 1 person

      Reply
      1. brucespoint

        “I” Want them to knOw just what I think of them, & Their Buddies ideas, Border Crossing has Always been a hassle here, the Irony of that not lost on me at all.
        Or, Joke’em if they Cannot take a ****!!
        =8^)
        b.
        Facebook 4 Chronics Has done Wonders..

        Like

        Reply
    1. Zyp Czyk Post author

      The medical profession will never go back to the powerful and independent force it used to be. When doctors act only as self-serving employees, they are no better than a lowly worker on an assembly line – and I know that doctors these days are feeling that way too. The “rogue capitalism” that’s being allowed to run amok these days is corrupting and bleeding dry more and more parts of our society.

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  2. canarensis

    I can’t believe it’s only 40%; back in 2013 –before the CDC BS even– I could not get a GP just for my thyroid med ONLY when I moved to a new town b/c I was a FORMER pain patient (no pain doc or meds after I moved cross country). I had to drive a 5 hour round trip every month for nearly a year to a free clinic at a fire station to have a doctor write a prescription for synthroid, which is not a street drug in any way, shape, or universe. And if you’re severely hypothyroid, ya can’t just stop the stuff for a year or two, unless you wanna die real slow. But by god, not one doc in my new town would allow me to walk in the door (literally). It’s gotta be wayyyy worse now, since Guideline Hell began.

    Every single doc office asked the same first question when called about new patients, and it wasn’t anything about insurance; it was, “Are you or have you ever been a pain patient or taken opioids for pain?” “Yes” & they immediately said “sorry, we cannot see you. *click*”

    couple months after I moved (& already had done the 5 hour round trip twice), the small local paper had an editorial by the local sheriff claiming that it was so easy to get opioid drugs, you could call any doctor’s office in town, make an appointment, and walk out with tons of opioids and refills. Anybody could get ’em, any time, any amount, even if they weren’t a patient of the clinic or even a resident of the state. I wrote what could be described as a blistering response, which they published. Never did see the sheriff admitting he was a lying sack, amazingly enough.

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      I can’t believe they are giving you a hard time with synthroid which isn’t on anyone’s “addictive drugs” list. I, too, thought 40% was far too low, since I know of several people who haven’t been able to find a new doctor since they lost their current doc. It’s infuriating to be so dependent on a healthcare system so broken, in which a patient’s cries of pain are twisted into “drug seeking” or “pain behavior” and

      Liked by 1 person

      Reply
      1. canarensis

        I know…it’s just so far beyond insane that even my supposedly huge vocabulary just can’t come up with the words. I finally got some reprieve from the idiotic situation when I hit the same volunteer doc for the 2nd time…he asked me why I kept coming back so far just for synthroid. I explained that none of the 7 or 8 doc offices in my new town would allow me to set foot in their precious office because I was such a dangerous character –former pain patient. He gaped at me for quite a while, did some creative cussing, said that was the most asinine thing he’d ever heard, & wrote me a Synthroid scrip with a years’ worth of refills. Bless his heart, I wish I remembered his name; I’da sent him a thank you note (that visit was actually on my birthday, so he gave me a nice & extremely useful B-day gift).

        Now, instead of a 5 hour round trip, I live just down the street from the same fire station & they have the same free clinics every coupla months. I figure it’ll be just a matter of time before my horridly dangerous, anti-social, evil choice of being a pain patient gets me kicked out of the regular medical establishment…at least I should still be able to get the synthroid.

        Liked by 1 person

        Reply
        1. Zyp Czyk Post author

          Wow, now US citizens have to get their healthcare from occasional “free clinics” at fire stations?! My hubby holds a clinic like that for bicycle repairs (mostly for bike commuters) at the library once a month! At least there are volunteers willing to give away their work for free when folks can’t afford what they desperately need.

          Liked by 1 person

          Reply
          1. canarensis

            Good for him! Yeah, the people –the volunteers– were actually MUCH nicer, more compassionate, & all ’round more pleasant than any doc office I’ve been to in years, other than the one who retired a few years ago. They even sang “happy birthday” to me when they saw my driver’s license. I admit that when the doc reacted so strongly to how asinine a situation I was in, & said so, I burst into tears…a doctor actually wanting to treat a patient well was such a shock I sorta lost it.

            And that right there says an awful lot about our “greatest health care in the world” (which it sure ain’t!). I really don’t tend to burst into tears in public without a damned good reason.

            Liked by 1 person

            Reply
            1. Zyp Czyk Post author

              Isn’t it odd that when we’re in terrible distress and full of fear and anger, just a few heartfelt sympathetic words cause us to “melt” – maybe because we feel we can finally relax, that we can stop fighting for our survival and put down our guard because someone finally “gets it”. Yes, it’s happened to me too.

              Liked by 1 person

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