Access to opioids in people with chronic pain

A recent study illustrates the negative impact of changes to opioid prescription policies in chronic pain patients receiving opioids.

Investigators at the University of Michigan have discovered that guidelines and policies to reduce inappropriate prescription of opioids could have unintended consequences on people with chronic pain, including conversion to illicit substances.

Using a simulated audit method of patient calls, the investigators badessed the practitioner's willingness to accept and continue to prescribe opioids to a new patient with pain. and to determine whether this willingness differed or not between different types of payers. The investigators obtained a list of 4,850 primary care practitioners from Michigan from a commercial database.

Of the 4850, a group of 667 clinics were selected and stratified by practice size (1 to 3 or more than 3 practitioners). Investigators simulated patient calls, in which research badistants used a standardized text to pose as an adult woman needing a new appointment for primary care, at these clinics between June 22 and October 30, 2018.

Clinics were asked about the number and type of practitioners, insurance coverage, availability of appointments and whether their practitioners were using drugs to treat opioid consumption disorders (OUD).

Of the 667 clinics screened, 219 were eligible after inclusion criteria were applied. Of the eligible clinics, 88.6% (194) responded to the pre-established call. Of this group, 94 clinics were badigned to mock calls from patients with Medicaid and 100 to Blue Cross Blue Shield.

The investigators found that 40.7% of the clinics called reported not providing care to new opioid patients, 17% requested additional information and 41.8% were willing to make an appointment for the first time. After receiving the requested information, 1 clinic accepted the patient, 4 did not, 20 said that the practitioner would decide to prescribe after the first visit, 7 indicated that they would direct the patient to a pain clinic and 1 requested a faxed medical record.

When comparing results based on the number of practitioners, the investigators noted that single-practitioner clinics were more likely than clinics with 3 or more practitioners to accept new patients currently taking opioids (OR, 2.99, 95% CI, 1.48-6.04). The investigators found that clinics that were community health centers were more likely to accept new patients taking opioids. No difference was observed when comparing the rate of acceptance based on the status of insurance.

In their conclusion, investigators noted that policy changes that affect access may cause a patient to search for illicit substances or reduce the management of other comorbidities.

This study entitled "Access to Primary Care Clinics for Chronic Pain Patients Receiving Opioids" is published in JAMA network open.